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This is VAERS ID 1440637

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1440637
VAERS Form:2
Age:31.0
Sex:Female
Location:Missouri
Vaccinated:2021-07-01
Onset:2021-07-01
Submitted:0000-00-00
Entered:2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Headache, Nausea, Throat irritation, Eye pruritus

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ortho cycline
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: Benedryl
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Pt received the vaccine 07/01/21 at 9:50. pt went home after the shot. she called the pharmacy at 11:20 stating that she was nauseous, headache, itchy eyes and scratchy throat. pe pt discussion in the past she had and allergy to benedryl (paridoxical rxn with benedryl causing anaphylaxis). due to this I instructed her to go to the ER and seek treatment.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1440637&WAYBACKHISTORY=ON


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