Adverse Event Reporting

VAERS ID 907042
Gender Female
Age 42
StateCode ID
Pharmaceutical Company PFIZER\BIONTECH
Lot Number EK5730
Number of vaccinations 1
Vaccinated 2020-12-21
Onset 2020-12-21
Condition Life Threatening Recovered
  • Dizziness
  • Paraesthesia
  • Paraesthesia oral
  • Blood pressure increased
  • Nausea
  • Pulse abnormal
  • Rash
  • Abdominal pain upper
  • Swollen tongue
  • Wheezing
  • Throat irritation
  • Rash erythematous
  • Eye swelling
  • Ocular discomfort
  • Dysphonia
  • Rash pruritic
  • Tongue pruritus
  • Dry eye

Current Illness


Preexisting Conditions

Asthma, PCOS, diverticuli

Other Medications

Vitamin D, Claritin, magnesium, Zoloft

Previous Vaccinations

Arm became swollen after receiving flu shot with preservative in 2010


Raglan, morphine, erythromycin, Zithromax, sulfa, macrobid, latex sensitivity, egg sensitivity, gluten sensitivity, gold

Laboratory Data



Received vaccine around 10:40 am, by 10:50 started to feel dizzy, eyes felt full, dry, tingly, swollen, voice became raspy and throat itched.
Received 25 mg Benadryl PO at around 10:55.
Face, arms, chest and abdomen developed a fine red itchy rash, tongue swollen and itchy, lips tingling, wheezing, blood pressure elevated, pulse thready given 25 mg PO Benadryl, taken to the Emergency Room, symptoms persisted, stomach hurt became nauseated, received IV solumedrol, Pepcid, IV fluids, nebulized albuterol.
Sent home once stable after 3 hours, with instruction to take Benadryl every 4-6 hours fir the next 2 days, albuterol as needed, and prednisone for the next 5 days.