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This is VAERS ID 943073

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 943073
VAERS Form:2
Age:39.0
Sex:Female
Location:Connecticut
Vaccinated:2021-01-07
Onset:2021-01-07
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Anaphylactic reaction, Vomiting

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: Shellfish, latex, nickel, reglan, zantac, and patient reported allergy to "various unidentified substances"
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Systemic: Anaphylaxis-Severe, Systemic: Vomiting; symptoms lasted 2 days


Changed on 5/7/2021

VAERS ID: 943073 Before After
VAERS Form:2
Age:39.0
Sex:Female
Location:Connecticut
Vaccinated:2021-01-07
Onset:2021-01-07
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Anaphylactic reaction, Vomiting

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: Shellfish, latex, nickel, reglan, zantac, and patient reported allergy to "various unidentified substances" substances"
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Systemic: Anaphylaxis-Severe, Systemic: Vomiting; symptoms lasted 2 days


Changed on 5/21/2021

VAERS ID: 943073 Before After
VAERS Form:2
Age:39.0
Sex:Female
Location:Connecticut
Vaccinated:2021-01-07
Onset:2021-01-07
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Anaphylactic reaction, Vomiting

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: Shellfish, latex, nickel, reglan, zantac, and patient reported allergy to "various unidentified substances" substances"
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Systemic: Anaphylaxis-Severe, Systemic: Vomiting; symptoms lasted 2 days

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