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This is VAERS ID 908003

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 908003
VAERS Form:2
Age:44.0
Sex:Female
Location:Michigan
Vaccinated:2020-12-21
Onset:2020-12-21
Submitted:0000-00-00
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ELO140 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Anaphylactic reaction, Chest discomfort, Dyspnoea, Electrocardiogram, Tachycardia, 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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ibuprophen
Current Illness: none
Preexisting Conditions: none
Allergies: Gadolinium MRI dye
Diagnostic Lab Data: EPINEPHRINE, SOLUMEDROL, BENADRYL, PEPCID, EKG (ST). 12/21 3:14PM REPEAT EVENT 12/22 WITH ADMISSION TO OBS UNIT FOR OBSERVATION
CDC 'Split Type':

Write-up: ANAPHLACTIC REACTION, SOB, CHEST PRESSURE, TIGHTNESS IN THROAT, TACHYCARDIA


Changed on 5/7/2021

VAERS ID: 908003 Before After
VAERS Form:2
Age:44.0
Sex:Female
Location:Michigan
Vaccinated:2020-12-21
Onset:2020-12-21
Submitted:0000-00-00
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ELO140 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Anaphylactic reaction, Chest discomfort, Dyspnoea, Electrocardiogram, Tachycardia, 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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ibuprophen
Current Illness: none
Preexisting Conditions: none
Allergies: Gadolinium MRI dye dye
Diagnostic Lab Data: EPINEPHRINE, SOLUMEDROL, BENADRYL, PEPCID, EKG (ST). 12/21 3:14PM REPEAT EVENT 12/22 WITH ADMISSION TO OBS UNIT FOR OBSERVATION
CDC 'Split Type':

Write-up: ANAPHLACTIC REACTION, SOB, CHEST PRESSURE, TIGHTNESS IN THROAT, TACHYCARDIA


Changed on 5/14/2021

VAERS ID: 908003 Before After
VAERS Form:2
Age:44.0
Sex:Female
Location:Michigan
Vaccinated:2020-12-21
Onset:2020-12-21
Submitted:0000-00-00
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ELO140 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Anaphylactic reaction, Chest discomfort, Dyspnoea, Electrocardiogram, Tachycardia, 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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ibuprophen
Current Illness: none
Preexisting Conditions: none
Allergies: Gadolinium MRI dye dye
Diagnostic Lab Data: EPINEPHRINE, SOLUMEDROL, BENADRYL, PEPCID, EKG (ST). 12/21 3:14PM REPEAT EVENT 12/22 WITH ADMISSION TO OBS UNIT FOR OBSERVATION
CDC 'Split Type':

Write-up: ANAPHLACTIC REACTION, SOB, CHEST PRESSURE, TIGHTNESS IN THROAT, TACHYCARDIA

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