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This is VAERS ID 905446

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 905446
VAERS Form:2
Age:33.0
Sex:Female
Location:Washington
Vaccinated:2020-12-21
Onset:2020-12-21
Submitted:0000-00-00
Entered:2020-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Anaphylactic reaction, Cough, Dysphagia, Dyspnoea, Urticaria

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol MDI PRN for Asthma
Current Illness: none known
Preexisting Conditions: Asthma hx with grass pollen
Allergies: Grass pollen
Diagnostic Lab Data: Patient evaluated and treated in ED dept. Treated for anaphylaxis reaction to vaccine
CDC 'Split Type':

Write-up: Patient received Pfizer vaccine dose 1 IM in L deltoid per portcol. During 15 min post vaccine monitoring, patient developed a cough, SOB, diff swallowing and hive like rash within 10 minutes of vaccine administration


Changed on 5/7/2021

VAERS ID: 905446 Before After
VAERS Form:2
Age:33.0
Sex:Female
Location:Washington
Vaccinated:2020-12-21
Onset:2020-12-21
Submitted:0000-00-00
Entered:2020-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Anaphylactic reaction, Cough, Dysphagia, Dyspnoea, Urticaria

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol MDI PRN for Asthma
Current Illness: none known
Preexisting Conditions: Asthma hx with grass pollen
Allergies: Grass pollen pollen
Diagnostic Lab Data: Patient evaluated and treated in ED dept. Treated for anaphylaxis reaction to vaccine
CDC 'Split Type':

Write-up: Patient received Pfizer vaccine dose 1 IM in L deltoid per portcol. During 15 min post vaccine monitoring, patient developed a cough, SOB, diff swallowing and hive like rash within 10 minutes of vaccine administration


Changed on 5/14/2021

VAERS ID: 905446 Before After
VAERS Form:2
Age:33.0
Sex:Female
Location:Washington
Vaccinated:2020-12-21
Onset:2020-12-21
Submitted:0000-00-00
Entered:2020-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Anaphylactic reaction, Cough, Dysphagia, Dyspnoea, Urticaria

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol MDI PRN for Asthma
Current Illness: none known
Preexisting Conditions: Asthma hx with grass pollen
Allergies: Grass pollen pollen
Diagnostic Lab Data: Patient evaluated and treated in ED dept. Treated for anaphylaxis reaction to vaccine
CDC 'Split Type':

Write-up: Patient received Pfizer vaccine dose 1 IM in L deltoid per portcol. During 15 min post vaccine monitoring, patient developed a cough, SOB, diff swallowing and hive like rash within 10 minutes of vaccine administration

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=905446&WAYBACKHISTORY=ON

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