National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 903514

History of Changes from the VAERS Wayback Machine

First Appeared on 12/24/2020

VAERS ID: 903514
VAERS Form:2
Age:58.0
Sex:Male
Location:New Jersey
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Dizziness, Pruritus, Rash, Rash erythematous, Rash maculo-papular, Urticaria

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: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vaccine recipient was administered the vaccine at 11:30 am and then around 1:30 pm started to feel dizzy with hives and itching to his arms. The vaccine recipient was sent to the emergency department for further evaluation. There was an erythematous macular/papular rash on bilateral arms. He was administered diphenhydramine 12.5 mg IV, famotidine 20 mg IV, and methylprednisolone 125 mg IV. After reexamining, the patient felt much better, no dizziness, no itching, and no rash. He was discharge to home at 4:57 pm same day.


Changed on 12/30/2020

VAERS ID: 903514 Before After
VAERS Form:2
Age:58.0
Sex:Male
Location:New Jersey
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Dizziness, Pruritus, Rash, Rash erythematous, Rash maculo-papular, Urticaria

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: no
Current Illness: no
Preexisting Conditions: no
Allergies: no no
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vaccine recipient was administered the vaccine at 11:30 am and then around 1:30 pm started to feel dizzy with hives and itching to his arms. The vaccine recipient was sent to the emergency department for further evaluation. There was an erythematous macular/papular rash on bilateral arms. He was administered diphenhydramine 12.5 mg IV, famotidine 20 mg IV, and methylprednisolone 125 mg IV. After reexamining, the patient felt much better, no dizziness, no itching, and no rash. He was discharge to home at 4:57 pm same day.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=903514&WAYBACKHISTORY=ON


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