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This is VAERS ID 907022

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 907022
VAERS Form:2
Age:44.0
Sex:Female
Location:Ohio
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 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Anaphylactic reaction, Angioedema, Endotracheal intubation

Life Threatening? Yes
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Calcium 600 mg with D daily; Women''s Multiple vitamin daily; Vitamin D3 5,000 units daily; Zyrtec 10 mg at bedtime PRN; Celebrex 200 mg daily; Gabapentin 300 mg (3 caps daily); Melatonin 9 mg daily PRN; Zanaflex 4 mg Daily
Current Illness: Not known
Preexisting Conditions: Anxiety; Depression; Chronic Back Pain
Allergies: Morphine; Tramadol; NSAIDs; Codeine; Oxycodone; Percocet
Diagnostic Lab Data: None at this time
CDC 'Split Type':

Write-up: Anaphylaxis/Angioedema Patient was given EpiPen 0.3 mg IM; Methylprednisolone 125 mg once; Diphenhydramine 25 mg IV push once; Famotidine 20 mg IV push once; Dexamethasone 10 mg IV push once Patient was intubated and put on propofol and midazolam drips for sedation


Changed on 5/7/2021

VAERS ID: 907022 Before After
VAERS Form:2
Age:44.0
Sex:Female
Location:Ohio
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 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Anaphylactic reaction, Angioedema, Endotracheal intubation

Life Threatening? Yes
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Calcium 600 mg with D daily; Women''s Multiple vitamin daily; Vitamin D3 5,000 units daily; Zyrtec 10 mg at bedtime PRN; Celebrex 200 mg daily; Gabapentin 300 mg (3 caps daily); Melatonin 9 mg daily PRN; Zanaflex 4 mg Daily
Current Illness: Not known
Preexisting Conditions: Anxiety; Depression; Chronic Back Pain
Allergies: Morphine; Tramadol; NSAIDs; Codeine; Oxycodone; Percocet Percocet
Diagnostic Lab Data: None at this time
CDC 'Split Type':

Write-up: Anaphylaxis/Angioedema Patient was given EpiPen 0.3 mg IM; Methylprednisolone 125 mg once; Diphenhydramine 25 mg IV push once; Famotidine 20 mg IV push once; Dexamethasone 10 mg IV push once Patient was intubated and put on propofol and midazolam drips for sedation


Changed on 5/14/2021

VAERS ID: 907022 Before After
VAERS Form:2
Age:44.0
Sex:Female
Location:Ohio
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 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Anaphylactic reaction, Angioedema, Endotracheal intubation

Life Threatening? Yes
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Calcium 600 mg with D daily; Women''s Multiple vitamin daily; Vitamin D3 5,000 units daily; Zyrtec 10 mg at bedtime PRN; Celebrex 200 mg daily; Gabapentin 300 mg (3 caps daily); Melatonin 9 mg daily PRN; Zanaflex 4 mg Daily
Current Illness: Not known
Preexisting Conditions: Anxiety; Depression; Chronic Back Pain
Allergies: Morphine; Tramadol; NSAIDs; Codeine; Oxycodone; Percocet Percocet
Diagnostic Lab Data: None at this time
CDC 'Split Type':

Write-up: Anaphylaxis/Angioedema Patient was given EpiPen 0.3 mg IM; Methylprednisolone 125 mg once; Diphenhydramine 25 mg IV push once; Famotidine 20 mg IV push once; Dexamethasone 10 mg IV push once Patient was intubated and put on propofol and midazolam drips for sedation

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=907022&WAYBACKHISTORY=ON

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