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This is VAERS ID 1762484

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1762484
VAERS Form:2
Age:59.0
Sex:Female
Location:Ohio
Vaccinated:2021-10-04
Onset:2021-10-04
Submitted:0000-00-00
Entered:2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C2114 / 1 LA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chest pain, Dyspnoea, Swollen tongue, Throat tightness, Muscle tightness

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamictal 200mg Avery morning Prilosec 30mg daily
Current Illness: None
Preexisting Conditions: None
Allergies: Seafood, strawberries, bactrim , bee stings
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Tightness in throat and jaw, tongue swelling, shortness of breath., chest pain Treatment at the ER with Benadryl and Pepcid

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