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This is VAERS ID 1087939

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 1087939
VAERS Form:2
Age:17.0
Sex:Female
Location:Oklahoma
Vaccinated:2021-01-18
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / IM

Administered by: Other      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: none
Current Illness: none
Preexisting Conditions: asthma
Allergies: none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Rash on body day


Changed on 5/14/2021

VAERS ID: 1087939 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Oklahoma
Vaccinated:2021-01-18
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / IM

Administered by: Other      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: none
Current Illness: none
Preexisting Conditions: asthma
Allergies: none none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Rash on body day

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