National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 906418

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 906418
VAERS Form:2
Age:36.0
Sex:Female
Location:Alabama
Vaccinated:2020-12-21
Onset:2020-12-22
Submitted:0000-00-00
Entered:2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O11J20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Headache, Pyrexia, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cozaar 25mg by mouth daily. Vitamin D3 2,000 units by mouth daily.
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin allergy- break out in rash Codeine allergy- break out in rash
Diagnostic Lab Data: Rapid Covid-19 test done on 12/22/20. Results were Negative.
CDC 'Split Type':

Write-up: Headache Fever- temp as high as 102.7


Changed on 5/7/2021

VAERS ID: 906418 Before After
VAERS Form:2
Age:36.0
Sex:Female
Location:Alabama
Vaccinated:2020-12-21
Onset:2020-12-22
Submitted:0000-00-00
Entered:2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O11J20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Headache, Pyrexia, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cozaar 25mg by mouth daily. Vitamin D3 2,000 units by mouth daily.
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin allergy- break out in rash Codeine allergy- break out in rash rash
Diagnostic Lab Data: Rapid Covid-19 test done on 12/22/20. Results were Negative.
CDC 'Split Type':

Write-up: Headache Fever- temp as high as 102.7


Changed on 5/14/2021

VAERS ID: 906418 Before After
VAERS Form:2
Age:36.0
Sex:Female
Location:Alabama
Vaccinated:2020-12-21
Onset:2020-12-22
Submitted:0000-00-00
Entered:2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O11J20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Headache, Pyrexia, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cozaar 25mg by mouth daily. Vitamin D3 2,000 units by mouth daily.
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin allergy- break out in rash Codeine allergy- break out in rash rash
Diagnostic Lab Data: Rapid Covid-19 test done on 12/22/20. Results were Negative.
CDC 'Split Type':

Write-up: Headache Fever- temp as high as 102.7

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=906418&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166