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This is VAERS ID 1385828

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1385828
VAERS Form:2
Age:50.0
Sex:Female
Location:Oregon
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Abdominal pain upper, Arthralgia, Back pain, Chest discomfort, Dizziness, Erythema, Headache, Nausea, Neck pain, Pain in extremity, Pruritus, Stomatitis, Swollen tongue, Tongue geographic, Urticaria, Weight increased, Wheezing

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: reaction to pneumovax shot 2015, age 45 with hives, extreme swelling of vaccination site and arm, shortness of breath and wheezi
Other Medications: Advair, Zyrtec, Singulair, multi vitamin
Current Illness: none
Preexisting Conditions: Asthma, COPD, Allergies, Von Willebrand''s, MVP, IBS, Bronchiectasis, Reynaud''s
Allergies: PCN, sulfa, Terbutaline, Iodine, Norafloxin, Macrobid, ASA, shellfish, strawberries, passionfruit, walnuts, pecans, beef, lactose intolerant, gluten intolerant, venom stings/bites, wool,
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Sore arm, head ache, back and shoulder ache (within 20 minutes), dizziness, extreme nausea and stomachache, wheezing, chest tightening, skin turning red, hives, itchiness, geographic tongue (1 hour 10 minutes after injection), mouth sores internal and external, swollen tongue, water weight around 5 pounds (48 hours after injection). Continued dizziness, headache, neck pain, swollen tongue, mouth sores, and continued itchiness as of today''s date (06/09/21).

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