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This is VAERS ID 909000

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 909000
VAERS Form:2
Age:63.0
Sex:Female
Location:California
Vaccinated:2020-12-21
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Anaphylactic reaction, Chest X-ray, Electrocardiogram, Laboratory test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Levothyroxine
Current Illness: Hashimotos thyroiditis
Preexisting Conditions: As above
Allergies: NKMA
Diagnostic Lab Data: Urgent care on 12/23 Labs/ steroids/ IV fluids/ EKG/ CXR
CDC 'Split Type':

Write-up: Subsequent idiopathic anaphylaxis event 1 1/2 days later


Changed on 5/7/2021

VAERS ID: 909000 Before After
VAERS Form:2
Age:63.0
Sex:Female
Location:California
Vaccinated:2020-12-21
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Anaphylactic reaction, Chest X-ray, Electrocardiogram, Laboratory test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Levothyroxine
Current Illness: Hashimotos thyroiditis
Preexisting Conditions: As above
Allergies: NKMA NKMA
Diagnostic Lab Data: Urgent care on 12/23 Labs/ steroids/ IV fluids/ EKG/ CXR
CDC 'Split Type':

Write-up: Subsequent idiopathic anaphylaxis event 1 1/2 days later


Changed on 5/14/2021

VAERS ID: 909000 Before After
VAERS Form:2
Age:63.0
Sex:Female
Location:California
Vaccinated:2020-12-21
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Anaphylactic reaction, Chest X-ray, Electrocardiogram, Laboratory test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Levothyroxine
Current Illness: Hashimotos thyroiditis
Preexisting Conditions: As above
Allergies: NKMA NKMA
Diagnostic Lab Data: Urgent care on 12/23 Labs/ steroids/ IV fluids/ EKG/ CXR
CDC 'Split Type':

Write-up: Subsequent idiopathic anaphylaxis event 1 1/2 days later

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