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This is VAERS ID 902794

History of Changes from the VAERS Wayback Machine

First Appeared on 12/18/2020

VAERS ID: 902794
VAERS Form:2
Age:35.0
Sex:Male
Location:Texas
Vaccinated:2020-12-15
Onset:2020-12-15
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: 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.


Changed on 12/24/2020

VAERS ID: 902794 Before After
VAERS Form:2
Age:35.0
Sex:Male
Location:Texas
Vaccinated:2020-12-15
Onset:2020-12-15
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: 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) (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.


Changed on 12/30/2020

VAERS ID: 902794 Before After
VAERS Form:2
Age:35.0
Sex:Male
Location:Texas
Vaccinated:2020-12-15
Onset:2020-12-15
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: 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) (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.


Changed on 5/7/2021

VAERS ID: 902794 Before After
VAERS Form:2
Age:35.0
Sex:Male
Location:Texas
Vaccinated:2020-12-15
Onset:2020-12-15
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: 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) (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.


Changed on 5/14/2021

VAERS ID: 902794 Before After
VAERS Form:2
Age:35.0
Sex:Male
Location:Texas
Vaccinated:2020-12-15
Onset:2020-12-15
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: 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) (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.

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

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