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From the 10/8/2021 release of VAERS data:

This is VAERS ID 926142



Case Details

VAERS ID: 926142 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-07
Onset:2021-01-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal pain upper, Anxiety, Nausea, Petechiae, Pruritus, Scratch, Somnolence, Vital signs measurement, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH Breast cancer with treatment with lymphnode removal and remission 2019
Allergies: Benadryl, IV Penicillin facewash (unknown)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt in clinic for 1st COVID vaccination. Nurse reviewed screening checklist, nurse queried pt related to severe reactions to any injected medications or immunization previously. Pt denied any severe reaction history to injected medications or immunizations. Pt was administered COVID Pfizer injection approx. 0900. At approx. 0910 pt returned to nurses room reporting having stomach cramping. Pt reports attempted to use bathroom without success. Nurse notified Lead Nurse, NP. Emergency kit obtained, vital signs collected while Lead Nurse consulted Nursing Director, DNP, per consultation Lead Nurse contacted 9-1-1. Pt SpO2 stable in high 90''s, pt did not present with difficulty breathing at that time, pt reported ongoing stomach pain and itching on abdomen. Pinprick petechiae observed on thoracic area, pt actively scratching. Per Lead Nurse, NP consultation with Nursing Director, DNP IM Bendaryl advised. Pt notified nurses of PMH allergy to Benadryl. Pt indicated when school-aged had anaphylactic reaction to penicillin and given IV Benadryl at that time, resulting in hives. Pt further reported allergic reaction to unknown facewash when 18 years old, when presented at MD office at that time was given IV Benadryl, subsequently sent to hospital at that time for severe reaction. Per consultation with Nursing Director epinephrine indicated. Nurse, RN administered epi-pen autoinjector 3mg at 09:22 (lot #G200810X, expiration 12/2021). Post epinephrine administration pt experienced nausea with vomiting and expressed feeling anxious. Pt affect became more somnolent with stomach upset. EMS arrived to clinic and pt consented to transport. Transfer of care to EMS approx. 09:45. RN


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