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This is VAERS ID 904504

History of Changes from the VAERS Wayback Machine

First Appeared on 12/24/2020

VAERS ID: 904504
VAERS Form:2
Age:60.0
Sex:Male
Location:Massachusetts
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: Anaphylactic reaction, Angioedema, Throat tightness

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: Rosuvastatin, meloxicam, omeprazole, vitamin D
Current Illness: None
Preexisting Conditions: High cholesterol, psoriasis, gerd
Allergies: Shellfish, iodine
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Throat closure (angioedema/anaphylaxis) requiring ambulance transport to Hospital emergency room and stay IV infusion of Benedryl, solumedrol, and Pepcid with excellent results. Observed twelve hours, then discharged.


Changed on 12/30/2020

VAERS ID: 904504 Before After
VAERS Form:2
Age:60.0
Sex:Male
Location:Massachusetts
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: Anaphylactic reaction, Angioedema, Throat tightness

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: Rosuvastatin, meloxicam, omeprazole, vitamin D
Current Illness: None
Preexisting Conditions: High cholesterol, psoriasis, gerd
Allergies: Shellfish, iodine iodine
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Throat closure (angioedema/anaphylaxis) requiring ambulance transport to Hospital emergency room and stay IV infusion of Benedryl, solumedrol, and Pepcid with excellent results. Observed twelve hours, then discharged.


Changed on 5/7/2021

VAERS ID: 904504 Before After
VAERS Form:2
Age:60.0
Sex:Male
Location:Massachusetts
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: Anaphylactic reaction, Angioedema, Throat tightness

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: Rosuvastatin, meloxicam, omeprazole, vitamin D
Current Illness: None
Preexisting Conditions: High cholesterol, psoriasis, gerd
Allergies: Shellfish, iodine iodine
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Throat closure (angioedema/anaphylaxis) requiring ambulance transport to Hospital emergency room and stay IV infusion of Benedryl, solumedrol, and Pepcid with excellent results. Observed twelve hours, then discharged.


Changed on 5/14/2021

VAERS ID: 904504 Before After
VAERS Form:2
Age:60.0
Sex:Male
Location:Massachusetts
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: Anaphylactic reaction, Angioedema, Throat tightness

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: Rosuvastatin, meloxicam, omeprazole, vitamin D
Current Illness: None
Preexisting Conditions: High cholesterol, psoriasis, gerd
Allergies: Shellfish, iodine iodine
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Throat closure (angioedema/anaphylaxis) requiring ambulance transport to Hospital emergency room and stay IV infusion of Benedryl, solumedrol, and Pepcid with excellent results. Observed twelve hours, then discharged.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=904504&WAYBACKHISTORY=ON

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