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This is VAERS ID 906315

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 906315
VAERS Form:2
Age:62.0
Sex:Female
Location:Connecticut
Vaccinated:2020-12-22
Onset:2020-12-22
Submitted:0000-00-00
Entered:2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Ear swelling, Erythema, Lip swelling

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: patient pre medicated self with Benadryl per instructions of her PCP
Current Illness: n/a
Preexisting Conditions: crohns
Allergies: Butalbital-aspirin-caffeine Iodinated Diagnostic Agents Meperidine Infliximab Montelukast Montelukast Sodium Penicillin G Azathioprine Adhesives/tape Codeine Latex Morphine Nsaids Penicillins Tetracycline
Diagnostic Lab Data: steroids administered in the Emergency Department
CDC 'Split Type':

Write-up: At 35min post vaccine patient noted with redness to the chest, neck and going up to face and bilateral ears. Ears were swollen. Patient transferred to the Emergency Department where she was noticed to have swollen lips


Changed on 5/7/2021

VAERS ID: 906315 Before After
VAERS Form:2
Age:62.0
Sex:Female
Location:Connecticut
Vaccinated:2020-12-22
Onset:2020-12-22
Submitted:0000-00-00
Entered:2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Ear swelling, Erythema, Lip swelling

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: patient pre medicated self with Benadryl per instructions of her PCP
Current Illness: n/a
Preexisting Conditions: crohns
Allergies: Butalbital-aspirin-caffeine Iodinated Diagnostic Agents Meperidine Infliximab Montelukast Montelukast Sodium Penicillin G Azathioprine Adhesives/tape Codeine Latex Morphine Nsaids Penicillins Tetracycline Tetracycline
Diagnostic Lab Data: steroids administered in the Emergency Department
CDC 'Split Type':

Write-up: At 35min post vaccine patient noted with redness to the chest, neck and going up to face and bilateral ears. Ears were swollen. Patient transferred to the Emergency Department where she was noticed to have swollen lips


Changed on 5/14/2021

VAERS ID: 906315 Before After
VAERS Form:2
Age:62.0
Sex:Female
Location:Connecticut
Vaccinated:2020-12-22
Onset:2020-12-22
Submitted:0000-00-00
Entered:2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Ear swelling, Erythema, Lip swelling

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: patient pre medicated self with Benadryl per instructions of her PCP
Current Illness: n/a
Preexisting Conditions: crohns
Allergies: Butalbital-aspirin-caffeine Iodinated Diagnostic Agents Meperidine Infliximab Montelukast Montelukast Sodium Penicillin G Azathioprine Adhesives/tape Codeine Latex Morphine Nsaids Penicillins Tetracycline Tetracycline
Diagnostic Lab Data: steroids administered in the Emergency Department
CDC 'Split Type':

Write-up: At 35min post vaccine patient noted with redness to the chest, neck and going up to face and bilateral ears. Ears were swollen. Patient transferred to the Emergency Department where she was noticed to have swollen lips

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=906315&WAYBACKHISTORY=ON


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