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This is VAERS ID 903504

History of Changes from the VAERS Wayback Machine

First Appeared on 12/24/2020

VAERS ID: 903504
VAERS Form:2
Age:55.0
Sex:Female
Location:Puerto Rico
Vaccinated:2020-12-15
Onset:2020-12-15
Submitted:0000-00-00
Entered:2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Pruritus

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: Penicillin
Diagnostic Lab Data: Vital signs 149/69 HR: 77, R:20
CDC 'Split Type': PR-04-20

Write-up: The patient began to feel itchy throughout the body, particularly both arms and the back. This happened 30 minutes after injecting her with the COVID-19 vaccine


Changed on 12/30/2020

VAERS ID: 903504 Before After
VAERS Form:2
Age:55.0
Sex:Female
Location:Puerto Rico
Vaccinated:2020-12-15
Onset:2020-12-15
Submitted:0000-00-00
Entered:2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Pruritus

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: Penicillin Penicillin
Diagnostic Lab Data: Vital signs 149/69 HR: 77, R:20
CDC 'Split Type': PR-04-20

Write-up: The patient began to feel itchy throughout the body, particularly both arms and the back. This happened 30 minutes after injecting her with the COVID-19 vaccine

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