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This is VAERS ID 903990

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/24/2020

VAERS ID: 903990
VAERS Form:2
Age:51.0
Sex:Female
Location:Colorado
Vaccinated:2020-12-18
Onset:2020-12-18
Submitted:0000-00-00
Entered:2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / UNK LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Dyspnoea, Injection site pain, Local reaction, Urticaria, Injection site streaking

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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: A cool item was placed on her arm. She was referred to the ER for medical clearance. She was evaluated, determined to have a local reaction and was discharged. Recommended to take benadryl if symptoms persist.
CDC 'Split Type':

Write-up: The individual developed a quarter size welt immediately after receiving the vaccine. Within the first 5-10 minutes post vaccination, the individual was complaining of pain at the injection site going down her arm, red streaks were visible from the injection site, and she did develop some difficulty breathing, which may have been related to the situation and the mask she was wearing.


Changed on 12/30/2020

VAERS ID: 903990 Before After
VAERS Form:2
Age:51.0
Sex:Female
Location:Colorado
Vaccinated:2020-12-18
Onset:2020-12-18
Submitted:0000-00-00
Entered:2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / UNK LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Dyspnoea, Injection site pain, Local reaction, Urticaria, Injection site streaking

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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: A cool item was placed on her arm. She was referred to the ER for medical clearance. She was evaluated, determined to have a local reaction and was discharged. Recommended to take benadryl if symptoms persist.
CDC 'Split Type':

Write-up: The individual developed a quarter size welt immediately after receiving the vaccine. Within the first 5-10 minutes post vaccination, the individual was complaining of pain at the injection site going down her arm, red streaks were visible from the injection site, and she did develop some difficulty breathing, which may have been related to the situation and the mask she was wearing.


Changed on 5/7/2021

VAERS ID: 903990 Before After
VAERS Form:2
Age:51.0
Sex:Female
Location:Colorado
Vaccinated:2020-12-18
Onset:2020-12-18
Submitted:0000-00-00
Entered:2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / UNK LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Dyspnoea, Injection site pain, Local reaction, Urticaria, Injection site streaking

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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: A cool item was placed on her arm. She was referred to the ER for medical clearance. She was evaluated, determined to have a local reaction and was discharged. Recommended to take benadryl if symptoms persist.
CDC 'Split Type':

Write-up: The individual developed a quarter size welt immediately after receiving the vaccine. Within the first 5-10 minutes post vaccination, the individual was complaining of pain at the injection site going down her arm, red streaks were visible from the injection site, and she did develop some difficulty breathing, which may have been related to the situation and the mask she was wearing.


Changed on 5/14/2021

VAERS ID: 903990 Before After
VAERS Form:2
Age:51.0
Sex:Female
Location:Colorado
Vaccinated:2020-12-18
Onset:2020-12-18
Submitted:0000-00-00
Entered:2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / UNK LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Dyspnoea, Injection site pain, Local reaction, Urticaria, Injection site streaking

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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: A cool item was placed on her arm. She was referred to the ER for medical clearance. She was evaluated, determined to have a local reaction and was discharged. Recommended to take benadryl if symptoms persist.
CDC 'Split Type':

Write-up: The individual developed a quarter size welt immediately after receiving the vaccine. Within the first 5-10 minutes post vaccination, the individual was complaining of pain at the injection site going down her arm, red streaks were visible from the injection site, and she did develop some difficulty breathing, which may have been related to the situation and the mask she was wearing.

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