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This is VAERS ID 947004

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 947004
VAERS Form:2
Age:17.0
Sex:Male
Location:California
Vaccinated:2021-01-14
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Rash

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt developed a bilateral rashes on the arms 10 min s/p COVID vaccine administration. No other symptoms were experienced. Pt received 20 mg of Famotidine and 25 mg of Diphenhydramine. Rash improved. Pt was monitored for 30 minutes, and was able to return home with no issues


Changed on 5/7/2021

VAERS ID: 947004 Before After
VAERS Form:2
Age:17.0
Sex:Male
Location:California
Vaccinated:2021-01-14
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Rash

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a n/a
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt developed a bilateral rashes on the arms 10 min s/p COVID vaccine administration. No other symptoms were experienced. Pt received 20 mg of Famotidine and 25 mg of Diphenhydramine. Rash improved. Pt was monitored for 30 minutes, and was able to return home with no issues


Changed on 5/21/2021

VAERS ID: 947004 Before After
VAERS Form:2
Age:17.0
Sex:Male
Location:California
Vaccinated:2021-01-14
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Rash

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a n/a
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt developed a bilateral rashes on the arms 10 min s/p COVID vaccine administration. No other symptoms were experienced. Pt received 20 mg of Famotidine and 25 mg of Diphenhydramine. Rash improved. Pt was monitored for 30 minutes, and was able to return home with no issues

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