National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 4/23/2021 release of VAERS data:

This is VAERS ID 902794



Case Details

VAERS ID: 902794 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Texas  
Vaccinated:2020-12-15
Onset:2020-12-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Swollen tongue, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Cilostazol, Dextroamphetamine/amphetamine; emtricitabine/tenofovir, ergocalciferol, lisinopril, warfarin.
Current Illness:
Preexisting Conditions: Anti-phospholipid syndrome, Hypertension, Sleep Apnea, Lupus anticoagulant ab positive, H/O MI.
Allergies: Niacin (palpitations)
Diagnostic Lab Data:
CDC Split Type:

Write-up: "Pfizer-BioNTech COVID-19 Vaccine EUA": Acute onset of tongue swelling, throat tightness, and diffuse erythema approximately 5 minutes after receiving COVID-19 vaccine. Patient transferred to emergency department. Patient treated with Epinephrine 0.3 mg IM X1 dose, Dexamethasone 10 mg IV x1 dose, Diphenhydramine 25 mg IV x1 dose. Patient discharged same day with resolution of symptoms.


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=902794


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