National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 914574

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 914574
VAERS Form:2
Age:43.0
Sex:Female
Location:West Virginia
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2020-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Anaphylactoid reaction, Tachycardia

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: shell fish, sulfa, codeine, erythromycin
Diagnostic Lab Data: given diphenhydramine 25 mg po then transported to ER which is attached to our hospital/ transport personnel had epi-pen in hand if needed
CDC 'Split Type':

Write-up: started as tachycardia, then started have anaphylaxis reaction


Changed on 5/7/2021

VAERS ID: 914574 Before After
VAERS Form:2
Age:43.0
Sex:Female
Location:West Virginia
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2020-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Anaphylactoid reaction, Tachycardia

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: shell fish, sulfa, codeine, erythromycin erythromycin
Diagnostic Lab Data: given diphenhydramine 25 mg po then transported to ER which is attached to our hospital/ transport personnel had epi-pen in hand if needed
CDC 'Split Type':

Write-up: started as tachycardia, then started have anaphylaxis reaction


Changed on 5/14/2021

VAERS ID: 914574 Before After
VAERS Form:2
Age:43.0
Sex:Female
Location:West Virginia
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2020-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Anaphylactoid reaction, Tachycardia

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: shell fish, sulfa, codeine, erythromycin erythromycin
Diagnostic Lab Data: given diphenhydramine 25 mg po then transported to ER which is attached to our hospital/ transport personnel had epi-pen in hand if needed
CDC 'Split Type':

Write-up: started as tachycardia, then started have anaphylaxis reaction

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=914574&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166