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This is VAERS ID 906931

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 906931
VAERS Form:2
Age:33.0
Sex:Female
Location:Colorado
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: Military      Purchased by: ??
Symptoms: Chest discomfort, Dizziness, Headache

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: Epidural steroid injection approximately 10 days prior
Current Illness:
Preexisting Conditions:
Allergies: Shellfish, Iodine, Sulfa
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt experienced headache and dizziness immediately after injection. Approximately 30 mins later the patient began experiencing chest tightness. The patient received 50mg Benadryl and was transferred to the emergency department within about 20 mins.


Changed on 5/7/2021

VAERS ID: 906931 Before After
VAERS Form:2
Age:33.0
Sex:Female
Location:Colorado
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: Military      Purchased by: ??
Symptoms: Chest discomfort, Dizziness, Headache

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: Epidural steroid injection approximately 10 days prior
Current Illness:
Preexisting Conditions:
Allergies: Shellfish, Iodine, Sulfa Sulfa
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt experienced headache and dizziness immediately after injection. Approximately 30 mins later the patient began experiencing chest tightness. The patient received 50mg Benadryl and was transferred to the emergency department within about 20 mins.


Changed on 5/14/2021

VAERS ID: 906931 Before After
VAERS Form:2
Age:33.0
Sex:Female
Location:Colorado
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: Military      Purchased by: ??
Symptoms: Chest discomfort, Dizziness, Headache

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: Epidural steroid injection approximately 10 days prior
Current Illness:
Preexisting Conditions:
Allergies: Shellfish, Iodine, Sulfa Sulfa
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt experienced headache and dizziness immediately after injection. Approximately 30 mins later the patient began experiencing chest tightness. The patient received 50mg Benadryl and was transferred to the emergency department within about 20 mins.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=906931&WAYBACKHISTORY=ON

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