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This is VAERS ID 907016

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 907016
VAERS Form:2
Age:40.0
Sex:Female
Location:Iowa
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 025J20-20 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Body temperature increased, Dizziness, Palpitations

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:
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient complained of "racing heart beat, dizziness" BP noted 141/92 P104 oxygen 99 repeat temp 97.6 BP 145/89 P96 repeat BP 145/95 Pulse 104 taken to ER for further evaluation and treatment. Temperature rose to 101 while in ER. Patient reports symptoms resolved approximately 1 1/2 hours after injection "feels fine" now Discharged home steady gait.


Changed on 5/7/2021

VAERS ID: 907016 Before After
VAERS Form:2
Age:40.0
Sex:Female
Location:Iowa
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 025J20-20 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Body temperature increased, Dizziness, Palpitations

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:
Current Illness:
Preexisting Conditions:
Allergies: NKA NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient complained of "racing heart beat, dizziness" BP noted 141/92 P104 oxygen 99 repeat temp 97.6 BP 145/89 P96 repeat BP 145/95 Pulse 104 taken to ER for further evaluation and treatment. Temperature rose to 101 while in ER. Patient reports symptoms resolved approximately 1 1/2 hours after injection "feels fine" now Discharged home steady gait.


Changed on 5/14/2021

VAERS ID: 907016 Before After
VAERS Form:2
Age:40.0
Sex:Female
Location:Iowa
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 025J20-20 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Body temperature increased, Dizziness, Palpitations

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:
Current Illness:
Preexisting Conditions:
Allergies: NKA NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient complained of "racing heart beat, dizziness" BP noted 141/92 P104 oxygen 99 repeat temp 97.6 BP 145/89 P96 repeat BP 145/95 Pulse 104 taken to ER for further evaluation and treatment. Temperature rose to 101 while in ER. Patient reports symptoms resolved approximately 1 1/2 hours after injection "feels fine" now Discharged home steady gait.

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