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This is VAERS ID 906572

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 906572
VAERS Form:2
Age:40.0
Sex:Female
Location:Missouri
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 01120A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Headache, Paraesthesia

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: Synthroid 88mcg one daily Multivitamin one at night
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: Penicillin
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: headache - pt reports she will take Tylenol , reports head is ongoing tingling between shoulders - resolved


Changed on 5/7/2021

VAERS ID: 906572 Before After
VAERS Form:2
Age:40.0
Sex:Female
Location:Missouri
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 01120A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Headache, Paraesthesia

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: Synthroid 88mcg one daily Multivitamin one at night
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: Penicillin Penicillin
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: headache - pt reports she will take Tylenol , reports head is ongoing tingling between shoulders - resolved


Changed on 5/14/2021

VAERS ID: 906572 Before After
VAERS Form:2
Age:40.0
Sex:Female
Location:Missouri
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 01120A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Headache, Paraesthesia

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: Synthroid 88mcg one daily Multivitamin one at night
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: Penicillin Penicillin
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: headache - pt reports she will take Tylenol , reports head is ongoing tingling between shoulders - resolved

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