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This is VAERS ID 906950

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 906950
VAERS Form:2
Age:57.0
Sex:Female
Location:Arizona
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 011J20A / 1 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Chills, Dizziness, Headache, Nausea, Pain, Pain in extremity, Syncope

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Severe headache chills, body aches, arm pain, Nausea, fainted on standing, dizziness


Changed on 5/7/2021

VAERS ID: 906950 Before After
VAERS Form:2
Age:57.0
Sex:Female
Location:Arizona
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 011J20A / 1 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Chills, Dizziness, Headache, Nausea, Pain, Pain in extremity, Syncope

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Severe headache chills, body aches, arm pain, Nausea, fainted on standing, dizziness


Changed on 5/14/2021

VAERS ID: 906950 Before After
VAERS Form:2
Age:57.0
Sex:Female
Location:Arizona
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 011J20A / 1 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Chills, Dizziness, Headache, Nausea, Pain, Pain in extremity, Syncope

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Severe headache chills, body aches, arm pain, Nausea, fainted on standing, dizziness

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