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This is VAERS ID 904210

History of Changes from the VAERS Wayback Machine

First Appeared on 12/24/2020

VAERS ID: 904210
VAERS Form:2
Age:32.0
Sex:Female
Location:Colorado
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Anaphylactic reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, metformin, lisinopril, wellbutrin, vitamin c, zinc, vitamin d, fish oil, vitamin b12
Current Illness: None
Preexisting Conditions: Anxiety, hypothyroid, pcos, migraine
Allergies: Latex
Diagnostic Lab Data: Emergency room visit on 12/17/20
CDC 'Split Type':

Write-up: Anaphylaxis within 15 minutes of administration


Changed on 12/30/2020

VAERS ID: 904210 Before After
VAERS Form:2
Age:32.0
Sex:Female
Location:Colorado
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Anaphylactic reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, metformin, lisinopril, wellbutrin, vitamin c, zinc, vitamin d, fish oil, vitamin b12
Current Illness: None
Preexisting Conditions: Anxiety, hypothyroid, pcos, migraine
Allergies: Latex Latex
Diagnostic Lab Data: Emergency room visit on 12/17/20
CDC 'Split Type':

Write-up: Anaphylaxis within 15 minutes of administration


Changed on 5/7/2021

VAERS ID: 904210 Before After
VAERS Form:2
Age:32.0
Sex:Female
Location:Colorado
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Anaphylactic reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, metformin, lisinopril, wellbutrin, vitamin c, zinc, vitamin d, fish oil, vitamin b12
Current Illness: None
Preexisting Conditions: Anxiety, hypothyroid, pcos, migraine
Allergies: Latex Latex
Diagnostic Lab Data: Emergency room visit on 12/17/20
CDC 'Split Type':

Write-up: Anaphylaxis within 15 minutes of administration


Changed on 5/14/2021

VAERS ID: 904210 Before After
VAERS Form:2
Age:32.0
Sex:Female
Location:Colorado
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Anaphylactic reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, metformin, lisinopril, wellbutrin, vitamin c, zinc, vitamin d, fish oil, vitamin b12
Current Illness: None
Preexisting Conditions: Anxiety, hypothyroid, pcos, migraine
Allergies: Latex Latex
Diagnostic Lab Data: Emergency room visit on 12/17/20
CDC 'Split Type':

Write-up: Anaphylaxis within 15 minutes of administration

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=904210&WAYBACKHISTORY=ON

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