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This is VAERS ID 905962

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 905962
VAERS Form:2
Age:35.0
Sex:Female
Location:Missouri
Vaccinated:2020-12-21
Onset:2020-12-21
Submitted:0000-00-00
Entered:2020-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001J20A / 1 - / IM

Administered by: Work      Purchased by: ??
Symptoms: Chest discomfort, Dyspnoea, Heart rate increased

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: NONE
Current Illness: NONE KNOWN
Preexisting Conditions: ASTHMA - TAKES NO MEDICATIONS ADHD - TAKES NO MEDICATIONS
Allergies: VANCOMYCIN - RASH
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: approximately 30 minutes after receiving the vaccine, patient reported development of symptoms including increased HR, chest tightness and mild shortness of breath. She presented to the ED and was evaluated. She was given diphenhydramine 25 mg IV x 1 1629, famotidine 40 mg iv x 1 @ 1630, methylprednisolone 125 mg iv x 1 at 1629. patient was observed for 90 minutes. She was without further symptoms, VSS and she was discharge to home in stable condition at 1800


Changed on 5/7/2021

VAERS ID: 905962 Before After
VAERS Form:2
Age:35.0
Sex:Female
Location:Missouri
Vaccinated:2020-12-21
Onset:2020-12-21
Submitted:0000-00-00
Entered:2020-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001J20A / 1 - / IM

Administered by: Work      Purchased by: ??
Symptoms: Chest discomfort, Dyspnoea, Heart rate increased

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: NONE
Current Illness: NONE KNOWN
Preexisting Conditions: ASTHMA - TAKES NO MEDICATIONS ADHD - TAKES NO MEDICATIONS
Allergies: VANCOMYCIN - RASH RASH
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: approximately 30 minutes after receiving the vaccine, patient reported development of symptoms including increased HR, chest tightness and mild shortness of breath. She presented to the ED and was evaluated. She was given diphenhydramine 25 mg IV x 1 1629, famotidine 40 mg iv x 1 @ 1630, methylprednisolone 125 mg iv x 1 at 1629. patient was observed for 90 minutes. She was without further symptoms, VSS and she was discharge to home in stable condition at 1800


Changed on 5/14/2021

VAERS ID: 905962 Before After
VAERS Form:2
Age:35.0
Sex:Female
Location:Missouri
Vaccinated:2020-12-21
Onset:2020-12-21
Submitted:0000-00-00
Entered:2020-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001J20A / 1 - / IM

Administered by: Work      Purchased by: ??
Symptoms: Chest discomfort, Dyspnoea, Heart rate increased

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: NONE
Current Illness: NONE KNOWN
Preexisting Conditions: ASTHMA - TAKES NO MEDICATIONS ADHD - TAKES NO MEDICATIONS
Allergies: VANCOMYCIN - RASH RASH
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: approximately 30 minutes after receiving the vaccine, patient reported development of symptoms including increased HR, chest tightness and mild shortness of breath. She presented to the ED and was evaluated. She was given diphenhydramine 25 mg IV x 1 1629, famotidine 40 mg iv x 1 @ 1630, methylprednisolone 125 mg iv x 1 at 1629. patient was observed for 90 minutes. She was without further symptoms, VSS and she was discharge to home in stable condition at 1800

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