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VAERS ID: 2265777

AGE: 50| SEX: M|State: HI

Description

Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Mild, Additional Details: Pt is aware of allergic reaction (swelling of eyes), he informed me that he's done this before. I've given pt two benadryls right after the shot and monitored pt for 30 minutes to make sure nothing happened to him. No allergic reaction happened after giving benadryl

Symptoms

Eye swelling, Hypersensitivity, Mouth swelling, Swelling face, Swollen tongue

Vaccines

VAX DATE: 01 May 2022 | ONSET DATE: 01 May 2022 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • 4
  • IM
  • LA
  • fk9894

RECVDATE:05 May 2022
CAGE_YR:50
CAGE_MO:
RPT_DATE:
DIED:
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:Y
LAB_DATA:
V_ADMINBY:PHM
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:05 May 2022
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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