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This is VAERS ID 1230964

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1230964
VAERS Form:2
Age:
Sex:Female
Location:New York
Vaccinated:2021-04-11
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Chills, Headache, Nausea, Pyrexia, Helicobacter gastritis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Helicobacter pylori infection
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: H. Pylori; chills; nausea; headache.; fever; This spontaneous case was reported by a consumer and describes the occurrence of HELICOBACTER GASTRITIS (H. Pylori) in a 65-year-old female patient who received mRNA-1273 for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Helicobacter pylori infection. On 11-Apr-2021, the patient received second dose of mRNA-1273 (Intramuscular) 2 dosage form. On 11-Apr-2021, the patient experienced PYREXIA (fever). On an unknown date, the patient experienced HELICOBACTER GASTRITIS (H. Pylori) (seriousness criterion medically significant), CHILLS (chills), NAUSEA (nausea) and HEADACHE (headache.). At the time of the report, HELICOBACTER GASTRITIS (H. Pylori), PYREXIA (fever), CHILLS (chills), NAUSEA (nausea) and HEADACHE (headache.) outcome was unknown. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded Reporter did not allow further contact; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded


Changed on 5/7/2021

VAERS ID: 1230964 Before After
VAERS Form:2
Age:
Sex:Female
Location:New York
Vaccinated:2021-04-11
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Chills, Headache, Nausea, Pyrexia, Helicobacter gastritis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Helicobacter pylori infection
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: H. Pylori; chills; nausea; headache.; fever; This spontaneous case was reported by a consumer and describes the occurrence of HELICOBACTER GASTRITIS (H. Pylori) in a 65-year-old female patient who received mRNA-1273 for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Helicobacter pylori infection. On 11-Apr-2021, the patient received second dose of mRNA-1273 (Intramuscular) 2 dosage form. On 11-Apr-2021, the patient experienced PYREXIA (fever). On an unknown date, the patient experienced HELICOBACTER GASTRITIS (H. Pylori) (seriousness criterion medically significant), CHILLS (chills), NAUSEA (nausea) and HEADACHE (headache.). At the time of the report, HELICOBACTER GASTRITIS (H. Pylori), PYREXIA (fever), CHILLS (chills), NAUSEA (nausea) and HEADACHE (headache.) outcome was unknown. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded Reporter did not allow further contact; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded


Changed on 5/14/2021

VAERS ID: 1230964 Before After
VAERS Form:2
Age:
Sex:Female
Location:New York
Vaccinated:2021-04-11
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Chills, Headache, Nausea, Pyrexia, Helicobacter gastritis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Helicobacter pylori infection
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: H. Pylori; chills; nausea; headache.; fever; This spontaneous case was reported by a consumer and describes the occurrence of HELICOBACTER GASTRITIS (H. Pylori) in a 65-year-old female patient who received mRNA-1273 for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Helicobacter pylori infection. On 11-Apr-2021, the patient received second dose of mRNA-1273 (Intramuscular) 2 dosage form. On 11-Apr-2021, the patient experienced PYREXIA (fever). On an unknown date, the patient experienced HELICOBACTER GASTRITIS (H. Pylori) (seriousness criterion medically significant), CHILLS (chills), NAUSEA (nausea) and HEADACHE (headache.). At the time of the report, HELICOBACTER GASTRITIS (H. Pylori), PYREXIA (fever), CHILLS (chills), NAUSEA (nausea) and HEADACHE (headache.) outcome was unknown. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded Reporter did not allow further contact; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1230964&WAYBACKHISTORY=ON


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