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This is VAERS ID 904115

History of Changes from the VAERS Wayback Machine

First Appeared on 12/24/2020

VAERS ID: 904115
VAERS Form:2
Age:42.0
Sex:Female
Location:Oklahoma
Vaccinated:2020-12-15
Onset:2020-12-16
Submitted:0000-00-00
Entered:2020-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Petechiae, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acyclovir 400mg tid, albuterol hfa 180mcg q4h prn, buproprion SR 100mg bid, diclofenac 1% gel 4g qid prn, gabapentin 100mg tid, hydroxychloroquine 200mg bid, ibuprofen 800mg q8h prn, loratadine 10mg qday prn, montelukast 10mg qhs, omeprazol
Current Illness:
Preexisting Conditions: left sided heart failure, raynaud''s syndrome, sick sinus syndrome, GERD, systemic lupus erythematosus
Allergies: codeine, latex
Diagnostic Lab Data:
CDC 'Split Type': IHS

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA PATIENT DEVELOPED HIVES ON INCISION SCARS ON HER RIGHT FOREARM AND CHEST AT 15 MINUTES POST VACCINATION. AT 24 HOURS POST VACCINATION, PATIENT DEVELOPED PETECHIAE ON INCISION SCAR ON CHEST AND LEFT COLLAR BONE.


Changed on 12/30/2020

VAERS ID: 904115 Before After
VAERS Form:2
Age:42.0
Sex:Female
Location:Oklahoma
Vaccinated:2020-12-15
Onset:2020-12-16
Submitted:0000-00-00
Entered:2020-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Petechiae, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acyclovir 400mg tid, albuterol hfa 180mcg q4h prn, buproprion SR 100mg bid, diclofenac 1% gel 4g qid prn, gabapentin 100mg tid, hydroxychloroquine 200mg bid, ibuprofen 800mg q8h prn, loratadine 10mg qday prn, montelukast 10mg qhs, omeprazol
Current Illness:
Preexisting Conditions: left sided heart failure, raynaud''s syndrome, sick sinus syndrome, GERD, systemic lupus erythematosus
Allergies: codeine, latex latex
Diagnostic Lab Data:
CDC 'Split Type': IHS

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA PATIENT DEVELOPED HIVES ON INCISION SCARS ON HER RIGHT FOREARM AND CHEST AT 15 MINUTES POST VACCINATION. AT 24 HOURS POST VACCINATION, PATIENT DEVELOPED PETECHIAE ON INCISION SCAR ON CHEST AND LEFT COLLAR BONE.


Changed on 1/29/2021

VAERS ID: 904115 Before After
VAERS Form:2
Age:42.0
Sex:Female
Location:Oklahoma
Vaccinated:2020-12-15
Onset:2020-12-16
Submitted:0000-00-00
Entered:2020-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Petechiae, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acyclovir 400mg tid, albuterol hfa 180mcg q4h prn, buproprion SR 100mg bid, diclofenac 1% gel 4g qid prn, gabapentin 100mg tid, hydroxychloroquine 200mg bid, ibuprofen 800mg q8h prn, loratadine 10mg qday prn, montelukast 10mg qhs, omeprazol
Current Illness:
Preexisting Conditions: left sided heart failure, raynaud''s syndrome, sick sinus syndrome, GERD, systemic lupus erythematosus
Allergies: codeine, latex
Diagnostic Lab Data:
CDC 'Split Type': IHS (blank)

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA PATIENT DEVELOPED HIVES ON INCISION SCARS ON HER RIGHT FOREARM AND CHEST AT 15 MINUTES POST VACCINATION. AT 24 HOURS POST VACCINATION, PATIENT DEVELOPED PETECHIAE ON INCISION SCAR ON CHEST AND LEFT COLLAR BONE.


Changed on 5/7/2021

VAERS ID: 904115 Before After
VAERS Form:2
Age:42.0
Sex:Female
Location:Oklahoma
Vaccinated:2020-12-15
Onset:2020-12-16
Submitted:0000-00-00
Entered:2020-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Petechiae, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acyclovir 400mg tid, albuterol hfa 180mcg q4h prn, buproprion SR 100mg bid, diclofenac 1% gel 4g qid prn, gabapentin 100mg tid, hydroxychloroquine 200mg bid, ibuprofen 800mg q8h prn, loratadine 10mg qday prn, montelukast 10mg qhs, omeprazol
Current Illness:
Preexisting Conditions: left sided heart failure, raynaud''s syndrome, sick sinus syndrome, GERD, systemic lupus erythematosus
Allergies: codeine, latex latex
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA PATIENT DEVELOPED HIVES ON INCISION SCARS ON HER RIGHT FOREARM AND CHEST AT 15 MINUTES POST VACCINATION. AT 24 HOURS POST VACCINATION, PATIENT DEVELOPED PETECHIAE ON INCISION SCAR ON CHEST AND LEFT COLLAR BONE.


Changed on 5/14/2021

VAERS ID: 904115 Before After
VAERS Form:2
Age:42.0
Sex:Female
Location:Oklahoma
Vaccinated:2020-12-15
Onset:2020-12-16
Submitted:0000-00-00
Entered:2020-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Petechiae, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acyclovir 400mg tid, albuterol hfa 180mcg q4h prn, buproprion SR 100mg bid, diclofenac 1% gel 4g qid prn, gabapentin 100mg tid, hydroxychloroquine 200mg bid, ibuprofen 800mg q8h prn, loratadine 10mg qday prn, montelukast 10mg qhs, omeprazol
Current Illness:
Preexisting Conditions: left sided heart failure, raynaud''s syndrome, sick sinus syndrome, GERD, systemic lupus erythematosus
Allergies: codeine, latex latex
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA PATIENT DEVELOPED HIVES ON INCISION SCARS ON HER RIGHT FOREARM AND CHEST AT 15 MINUTES POST VACCINATION. AT 24 HOURS POST VACCINATION, PATIENT DEVELOPED PETECHIAE ON INCISION SCAR ON CHEST AND LEFT COLLAR BONE.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=904115&WAYBACKHISTORY=ON


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