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This is VAERS ID 904334

History of Changes from the VAERS Wayback Machine

First Appeared on 12/24/2020

VAERS ID: 904334
VAERS Form:2
Age:29.0
Sex:Female
Location:Oregon
Vaccinated:2020-12-19
Onset:2020-12-19
Submitted:0000-00-00
Entered:2020-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Angioedema, Dyspnoea, Full blood count normal, Tachycardia, Urticaria, Metabolic function test normal

Life Threatening? Yes
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: none
Current Illness: none
Preexisting Conditions: none
Allergies: shrimp and eggs
Diagnostic Lab Data: CBC and BMP - normal
CDC 'Split Type':

Write-up: Angioedema, hives, tachycardia, shortness of breath


Changed on 12/30/2020

VAERS ID: 904334 Before After
VAERS Form:2
Age:29.0
Sex:Female
Location:Oregon
Vaccinated:2020-12-19
Onset:2020-12-19
Submitted:0000-00-00
Entered:2020-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Angioedema, Dyspnoea, Full blood count normal, Tachycardia, Urticaria, Metabolic function test normal

Life Threatening? Yes
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: none
Current Illness: none
Preexisting Conditions: none
Allergies: shrimp and eggs eggs
Diagnostic Lab Data: CBC and BMP - normal
CDC 'Split Type':

Write-up: Angioedema, hives, tachycardia, shortness of breath


Changed on 5/7/2021

VAERS ID: 904334 Before After
VAERS Form:2
Age:29.0
Sex:Female
Location:Oregon
Vaccinated:2020-12-19
Onset:2020-12-19
Submitted:0000-00-00
Entered:2020-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Angioedema, Dyspnoea, Full blood count normal, Tachycardia, Urticaria, Metabolic function test normal

Life Threatening? Yes
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: none
Current Illness: none
Preexisting Conditions: none
Allergies: shrimp and eggs eggs
Diagnostic Lab Data: CBC and BMP - normal
CDC 'Split Type':

Write-up: Angioedema, hives, tachycardia, shortness of breath


Changed on 5/14/2021

VAERS ID: 904334 Before After
VAERS Form:2
Age:29.0
Sex:Female
Location:Oregon
Vaccinated:2020-12-19
Onset:2020-12-19
Submitted:0000-00-00
Entered:2020-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Angioedema, Dyspnoea, Full blood count normal, Tachycardia, Urticaria, Metabolic function test normal

Life Threatening? Yes
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: none
Current Illness: none
Preexisting Conditions: none
Allergies: shrimp and eggs eggs
Diagnostic Lab Data: CBC and BMP - normal
CDC 'Split Type':

Write-up: Angioedema, hives, tachycardia, shortness of breath

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