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This is VAERS ID 1071691

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1071691
VAERS Form:2
Age:17.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-02-24
Onset:2021-02-24
Submitted:0000-00-00
Entered:2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Angiogram pulmonary normal, Blood glucose normal, Chest discomfort, Dizziness, Dyspnoea, Electrocardiogram, Fibrin D dimer, Full blood count normal, Mononucleosis heterophile test negative, Pyrexia, Sleep disorder, Impaired work ability, Metabolic function test abnormal, Troponin, Oropharyngeal discomfort, Streptococcus test, Human chorionic gonadotropin negative, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 50mg once daily, Multi-vitamin, Loryna once daily
Current Illness: None reported
Preexisting Conditions: Acne, Anxiety, exercised induced asthma
Allergies: No known allergies
Diagnostic Lab Data: Covid-19 PCR 2/26/21- Negative Rapid strep 2/26/21- Negative Troponin 2/26/21- Negative Serum pregnancy 2/26/21- Negative Monospot 2/26/21- Negative CBC with differential 2/26/21- normal D-dimer 2/26/21- elevated 1.37 CMP 2/26/21- normal except glucose 100 EKG 2/26/21- NSR, no ectopy, rate 80 bpm, rightward axis, nonspecific T wave changes. CT chest pulmonary angio 2/26/21- normal, No PE, no airspace disease.
CDC 'Split Type':

Write-up: Pt reports onset of dizziness, chest tightness, shortness of breath that started acutely 45 minutes to 1 hour after receiving her second Moderna vaccination on 2/24/21. She reported that she was told by her employer that the symptoms were due to the Moderna vaccine. She reportedly developed fever and some throat discomfort as well. Symptoms became persistent and disrupted sleep and was unable to work. She sought medical attention in the ER for persistent symptoms on 2/26/21. Extensive workup was essentially normal. She received Zofran, Decadron, IVFs, and Albuterol inhaler while in the ER. She reported improvement in her chest tightness and SOB after Albuterol. She was discharged home with instructions to f/u with her PCP in a couple of days for recheck.


Changed on 5/7/2021

VAERS ID: 1071691 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-02-24
Onset:2021-02-24
Submitted:0000-00-00
Entered:2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Angiogram pulmonary normal, Blood glucose normal, Chest discomfort, Dizziness, Dyspnoea, Electrocardiogram, Fibrin D dimer, Full blood count normal, Mononucleosis heterophile test negative, Pyrexia, Sleep disorder, Impaired work ability, Metabolic function test abnormal, Troponin, Oropharyngeal discomfort, Streptococcus test, Human chorionic gonadotropin negative, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 50mg once daily, Multi-vitamin, Loryna once daily
Current Illness: None reported
Preexisting Conditions: Acne, Anxiety, exercised induced asthma
Allergies: No known allergies allergies
Diagnostic Lab Data: Covid-19 PCR 2/26/21- Negative Rapid strep 2/26/21- Negative Troponin 2/26/21- Negative Serum pregnancy 2/26/21- Negative Monospot 2/26/21- Negative CBC with differential 2/26/21- normal D-dimer 2/26/21- elevated 1.37 CMP 2/26/21- normal except glucose 100 EKG 2/26/21- NSR, no ectopy, rate 80 bpm, rightward axis, nonspecific T wave changes. CT chest pulmonary angio 2/26/21- normal, No PE, no airspace disease.
CDC 'Split Type':

Write-up: Pt reports onset of dizziness, chest tightness, shortness of breath that started acutely 45 minutes to 1 hour after receiving her second Moderna vaccination on 2/24/21. She reported that she was told by her employer that the symptoms were due to the Moderna vaccine. She reportedly developed fever and some throat discomfort as well. Symptoms became persistent and disrupted sleep and was unable to work. She sought medical attention in the ER for persistent symptoms on 2/26/21. Extensive workup was essentially normal. She received Zofran, Decadron, IVFs, and Albuterol inhaler while in the ER. She reported improvement in her chest tightness and SOB after Albuterol. She was discharged home with instructions to f/u with her PCP in a couple of days for recheck.


Changed on 5/14/2021

VAERS ID: 1071691 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-02-24
Onset:2021-02-24
Submitted:0000-00-00
Entered:2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Angiogram pulmonary normal, Blood glucose normal, Chest discomfort, Dizziness, Dyspnoea, Electrocardiogram, Fibrin D dimer, Full blood count normal, Mononucleosis heterophile test negative, Pyrexia, Sleep disorder, Impaired work ability, Metabolic function test abnormal, Troponin, Oropharyngeal discomfort, Streptococcus test, Human chorionic gonadotropin negative, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 50mg once daily, Multi-vitamin, Loryna once daily
Current Illness: None reported
Preexisting Conditions: Acne, Anxiety, exercised induced asthma
Allergies: No known allergies allergies
Diagnostic Lab Data: Covid-19 PCR 2/26/21- Negative Rapid strep 2/26/21- Negative Troponin 2/26/21- Negative Serum pregnancy 2/26/21- Negative Monospot 2/26/21- Negative CBC with differential 2/26/21- normal D-dimer 2/26/21- elevated 1.37 CMP 2/26/21- normal except glucose 100 EKG 2/26/21- NSR, no ectopy, rate 80 bpm, rightward axis, nonspecific T wave changes. CT chest pulmonary angio 2/26/21- normal, No PE, no airspace disease.
CDC 'Split Type':

Write-up: Pt reports onset of dizziness, chest tightness, shortness of breath that started acutely 45 minutes to 1 hour after receiving her second Moderna vaccination on 2/24/21. She reported that she was told by her employer that the symptoms were due to the Moderna vaccine. She reportedly developed fever and some throat discomfort as well. Symptoms became persistent and disrupted sleep and was unable to work. She sought medical attention in the ER for persistent symptoms on 2/26/21. Extensive workup was essentially normal. She received Zofran, Decadron, IVFs, and Albuterol inhaler while in the ER. She reported improvement in her chest tightness and SOB after Albuterol. She was discharged home with instructions to f/u with her PCP in a couple of days for recheck.

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