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This is VAERS ID 906717

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 906717
VAERS Form:2
Age:18.0
Sex:Female
Location:Alaska
Vaccinated:2020-12-21
Onset:2020-12-21
Submitted:0000-00-00
Entered:2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Tachycardia, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Buproprion
Current Illness: None
Preexisting Conditions: None
Allergies: Dogs
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Urticaria, tachycardia at 10 minutes post injection in left arm and neck Treated with oral cetirizine and montelukast. Resolved within 15 minutes of treatment. Discharged in good condition with PO diphenhydramine as needed.


Changed on 5/7/2021

VAERS ID: 906717 Before After
VAERS Form:2
Age:18.0
Sex:Female
Location:Alaska
Vaccinated:2020-12-21
Onset:2020-12-21
Submitted:0000-00-00
Entered:2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Tachycardia, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Buproprion
Current Illness: None
Preexisting Conditions: None
Allergies: Dogs Dogs
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Urticaria, tachycardia at 10 minutes post injection in left arm and neck Treated with oral cetirizine and montelukast. Resolved within 15 minutes of treatment. Discharged in good condition with PO diphenhydramine as needed.


Changed on 5/14/2021

VAERS ID: 906717 Before After
VAERS Form:2
Age:18.0
Sex:Female
Location:Alaska
Vaccinated:2020-12-21
Onset:2020-12-21
Submitted:0000-00-00
Entered:2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Tachycardia, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Buproprion
Current Illness: None
Preexisting Conditions: None
Allergies: Dogs Dogs
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Urticaria, tachycardia at 10 minutes post injection in left arm and neck Treated with oral cetirizine and montelukast. Resolved within 15 minutes of treatment. Discharged in good condition with PO diphenhydramine as needed.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=906717&WAYBACKHISTORY=ON


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