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This is VAERS ID 906122

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/24/2020

VAERS ID: 906122
VAERS Form:2
Age:43.0
Sex:Male
Location:D.C.
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GH9899 / 1 LA / -

Administered by: Work      Purchased by: ??
Symptoms: Urticaria

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Food allergy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USPFIZER INC2020500616

Write-up: Hives; This is a spontaneous report from a contactable consumer. A 43-year-old male patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE; Lot number: GH9899), via an unspecified route of administration in the left arm, on 17Dec2020 at 09:00 (at the age of 43-years-old) at a single dose for COVID-19 immunization. Medical history included allergic to unknown food. The patient''s concomitant medications were not reported. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient experienced hives on 17Dec2020 at 16:00. The event was reported as non-serious and did not cause/prolong hospitalization. Therapeutic measures were taken as a result of the event, which included treatment with diphenhydramine hydrochloride (BENADRYL). The clinical outcome of hives was recovering. It was also reported that since the vaccination, the patient had not been tested for COVID-19. The batch/lot number for the vaccine, BNT162B2, was not provided and has been requested during follow up.


Changed on 12/30/2020

VAERS ID: 906122 Before After
VAERS Form:2
Age:43.0
Sex:Male
Location:D.C.
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GH9899 / 1 LA / -

Administered by: Work      Purchased by: ??
Symptoms: Urticaria

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Food allergy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USPFIZER INC2020500616

Write-up: Hives; This is a spontaneous report from a contactable consumer. A 43-year-old male patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE; Lot number: GH9899), via an unspecified route of administration in the left arm, on 17Dec2020 at 09:00 (at the age of 43-years-old) at a single dose for COVID-19 immunization. Medical history included allergic to unknown food. The patient''s concomitant medications were not reported. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient experienced hives on 17Dec2020 at 16:00. The event was reported as non-serious and did not cause/prolong hospitalization. Therapeutic measures were taken as a result of the event, which included treatment with diphenhydramine hydrochloride (BENADRYL). The clinical outcome of hives was recovering. It was also reported that since the vaccination, the patient had not been tested for COVID-19. The batch/lot number for the vaccine, BNT162B2, was not provided and has been requested during follow up.


Changed on 5/7/2021

VAERS ID: 906122 Before After
VAERS Form:2
Age:43.0
Sex:Male
Location:D.C.
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GH9899 / 1 LA / -

Administered by: Work      Purchased by: ??
Symptoms: Urticaria

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Food allergy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USPFIZER INC2020500616

Write-up: Hives; This is a spontaneous report from a contactable consumer. A 43-year-old male patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE; Lot number: GH9899), via an unspecified route of administration in the left arm, on 17Dec2020 at 09:00 (at the age of 43-years-old) at a single dose for COVID-19 immunization. Medical history included allergic to unknown food. The patient''s concomitant medications were not reported. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient experienced hives on 17Dec2020 at 16:00. The event was reported as non-serious and did not cause/prolong hospitalization. Therapeutic measures were taken as a result of the event, which included treatment with diphenhydramine hydrochloride (BENADRYL). The clinical outcome of hives was recovering. It was also reported that since the vaccination, the patient had not been tested for COVID-19. The batch/lot number for the vaccine, BNT162B2, was not provided and has been requested during follow up.


Changed on 5/21/2021

VAERS ID: 906122 Before After
VAERS Form:2
Age:43.0
Sex:Male
Location:D.C.
Vaccinated:2020-12-17
Onset:2020-12-17
Submitted:0000-00-00
Entered:2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GH9899 / 1 LA / -

Administered by: Work      Purchased by: ??
Symptoms: Urticaria

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Food allergy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USPFIZER INC2020500616

Write-up: Hives; This is a spontaneous report from a contactable consumer. A 43-year-old male patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE; Lot number: GH9899), via an unspecified route of administration in the left arm, on 17Dec2020 at 09:00 (at the age of 43-years-old) at a single dose for COVID-19 immunization. Medical history included allergic to unknown food. The patient''s concomitant medications were not reported. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient experienced hives on 17Dec2020 at 16:00. The event was reported as non-serious and did not cause/prolong hospitalization. Therapeutic measures were taken as a result of the event, which included treatment with diphenhydramine hydrochloride (BENADRYL). The clinical outcome of hives was recovering. It was also reported that since the vaccination, the patient had not been tested for COVID-19. The batch/lot number for the vaccine, BNT162B2, was not provided and has been requested during follow up.

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