VAERS ID: 1884930

AGE: 9| SEX: M|STATE: CA (United States)

Description

Client was vaccinated at 14:29. Around 1440 the observation nurse noted that the client was fanning himself. The client complained that he was feeling hot, Right arm and leg pruritus, new "throat pain" and dizziness. The observation nurse and POD lead then called emergency services at 1445 and initiated the anaphylaxis protocol. An epipen JR was administered (Lot # LFN341) IM to right thigh at 1451 and at 1457 0.4ml of Diphenhydramine (lot # 080008) was administered IM to R Deltoid by Nurse. EMS arrived at 1458 and hand off occurred to the crew at 1459. Transport to local Medical Center ER occurred at 1505.

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Symptoms

Dizziness, Pruritus, Oropharyngeal pain, Feeling hot

Vaccines

VAX DATE: 11-17-2021| ONSET DATE: 11-17-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH FK5127 IM RA

RECVDATE:11-19-2021
RPT_DATE:
CAGE_YR:9
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:
V_ADMINBY:OTH
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:11-18-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:Y
ALLERGIES:Peanut
V_FUNDBY:

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