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This is VAERS ID 909209

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 909209
VAERS Form:2
Age:35.0
Sex:Male
Location:Pennsylvania
Vaccinated:2020-12-24
Onset:2020-12-24
Submitted:0000-00-00
Entered:2020-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Anaphylactic reaction, Angioedema, Condition aggravated

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: Mild allergic reactions to flu vaccines, but due to history of septic pneumonia history x 2 as a result of influenza A, I take t
Other Medications: Lisinopril, Prilosec
Current Illness: none
Preexisting Conditions: History of anaphylaxis.
Allergies: Additives, steroids, fragrances, color dyes, bactrim
Diagnostic Lab Data: n/a.
CDC 'Split Type':

Write-up: Mild anaphylaxis with angioedema of the tongue within minutes of injection.


Changed on 5/7/2021

VAERS ID: 909209 Before After
VAERS Form:2
Age:35.0
Sex:Male
Location:Pennsylvania
Vaccinated:2020-12-24
Onset:2020-12-24
Submitted:0000-00-00
Entered:2020-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Anaphylactic reaction, Angioedema, Condition aggravated

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: Mild allergic reactions to flu vaccines, but due to history of septic pneumonia history x 2 as a result of influenza A, I take t
Other Medications: Lisinopril, Prilosec
Current Illness: none
Preexisting Conditions: History of anaphylaxis.
Allergies: Additives, steroids, fragrances, color dyes, bactrim bactrim
Diagnostic Lab Data: n/a.
CDC 'Split Type':

Write-up: Mild anaphylaxis with angioedema of the tongue within minutes of injection.


Changed on 5/14/2021

VAERS ID: 909209 Before After
VAERS Form:2
Age:35.0
Sex:Male
Location:Pennsylvania
Vaccinated:2020-12-24
Onset:2020-12-24
Submitted:0000-00-00
Entered:2020-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Anaphylactic reaction, Angioedema, Condition aggravated

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: Mild allergic reactions to flu vaccines, but due to history of septic pneumonia history x 2 as a result of influenza A, I take t
Other Medications: Lisinopril, Prilosec
Current Illness: none
Preexisting Conditions: History of anaphylaxis.
Allergies: Additives, steroids, fragrances, color dyes, bactrim bactrim
Diagnostic Lab Data: n/a.
CDC 'Split Type':

Write-up: Mild anaphylaxis with angioedema of the tongue within minutes of injection.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=909209&WAYBACKHISTORY=ON


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