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This is VAERS ID 913233

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 913233
VAERS Form:2
Age:56.0
Sex:Female
Location:Utah
Vaccinated:2020-12-29
Onset:2020-12-29
Submitted:0000-00-00
Entered:2020-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private      Purchased by: ??
Symptoms: Anaphylactic reaction, Oxygen saturation normal, Pruritus, Swollen tongue, Throat tightness, 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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 10:30 AM After receiving the COVID-19 vaccine, the patient experienced an anaphylaxis reaction that included, throat closing and tongue swelling sensation, itchiness, and hives on her bilateral arms and legs. Patient received 65 mg of Benadryl IV, 125 mg SoluMedrol IV, two doses of 0.3 epinephrine IM, 1 mg of Ativan, and 4 mg of Zofran, then taken to the ED for further monitoring. Patient was on 2L NC for comfort, sats in mid 90s off oxygen, and monitored the patient for a few hours. Patient discharged to home with stable vital signs off oxygen and a steady gait.


Changed on 5/7/2021

VAERS ID: 913233 Before After
VAERS Form:2
Age:56.0
Sex:Female
Location:Utah
Vaccinated:2020-12-29
Onset:2020-12-29
Submitted:0000-00-00
Entered:2020-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private      Purchased by: ??
Symptoms: Anaphylactic reaction, Oxygen saturation normal, Pruritus, Swollen tongue, Throat tightness, 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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 10:30 AM After receiving the COVID-19 vaccine, the patient experienced an anaphylaxis reaction that included, throat closing and tongue swelling sensation, itchiness, and hives on her bilateral arms and legs. Patient received 65 mg of Benadryl IV, 125 mg SoluMedrol IV, two doses of 0.3 epinephrine IM, 1 mg of Ativan, and 4 mg of Zofran, then taken to the ED for further monitoring. Patient was on 2L NC for comfort, sats in mid 90s off oxygen, and monitored the patient for a few hours. Patient discharged to home with stable vital signs off oxygen and a steady gait.


Changed on 5/14/2021

VAERS ID: 913233 Before After
VAERS Form:2
Age:56.0
Sex:Female
Location:Utah
Vaccinated:2020-12-29
Onset:2020-12-29
Submitted:0000-00-00
Entered:2020-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private      Purchased by: ??
Symptoms: Anaphylactic reaction, Oxygen saturation normal, Pruritus, Swollen tongue, Throat tightness, 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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 10:30 AM After receiving the COVID-19 vaccine, the patient experienced an anaphylaxis reaction that included, throat closing and tongue swelling sensation, itchiness, and hives on her bilateral arms and legs. Patient received 65 mg of Benadryl IV, 125 mg SoluMedrol IV, two doses of 0.3 epinephrine IM, 1 mg of Ativan, and 4 mg of Zofran, then taken to the ED for further monitoring. Patient was on 2L NC for comfort, sats in mid 90s off oxygen, and monitored the patient for a few hours. Patient discharged to home with stable vital signs off oxygen and a steady gait.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=913233&WAYBACKHISTORY=ON


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