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This is VAERS ID 914596

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 914596
VAERS Form:2
Age:39.0
Sex:Female
Location:Kentucky
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 EL0142 / UNK RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Anaphylactic reaction, Dyspnoea, Stridor

Life Threatening? Yes
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: orange and red dye
Diagnostic Lab Data: In ER and at Medical Center
CDC 'Split Type':

Write-up: Anaphalaxis reaction, stridor an unable to breathe. Happened in 30 seconds


Changed on 5/7/2021

VAERS ID: 914596 Before After
VAERS Form:2
Age:39.0
Sex:Female
Location:Kentucky
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 EL0142 / UNK RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Anaphylactic reaction, Dyspnoea, Stridor

Life Threatening? Yes
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: orange and red dye dye
Diagnostic Lab Data: In ER and at Medical Center
CDC 'Split Type':

Write-up: Anaphalaxis reaction, stridor an unable to breathe. Happened in 30 seconds


Changed on 5/14/2021

VAERS ID: 914596 Before After
VAERS Form:2
Age:39.0
Sex:Female
Location:Kentucky
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 EL0142 / UNK RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Anaphylactic reaction, Dyspnoea, Stridor

Life Threatening? Yes
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: orange and red dye dye
Diagnostic Lab Data: In ER and at Medical Center
CDC 'Split Type':

Write-up: Anaphalaxis reaction, stridor an unable to breathe. Happened in 30 seconds

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=914596&WAYBACKHISTORY=ON


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