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This is VAERS ID 907032

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 907032
VAERS Form:2
Age:63.0
Sex:Male
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 039K20A / UNK LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Pruritus

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Benedryl 50mg and Pepcid 20mg Tablet
Current Illness: none
Preexisting Conditions: High Blood Pressure
Allergies: no
Diagnostic Lab Data: na
CDC 'Split Type':

Write-up: States had generalized itching and ask for benedryl. 50mg Benedryl Tablet given PO after 10 minutes ask for Pepcid. After 15 minutes states he feels better and issues resolved


Changed on 5/7/2021

VAERS ID: 907032 Before After
VAERS Form:2
Age:63.0
Sex:Male
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 039K20A / UNK LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Pruritus

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Benedryl 50mg and Pepcid 20mg Tablet
Current Illness: none
Preexisting Conditions: High Blood Pressure
Allergies: no no
Diagnostic Lab Data: na
CDC 'Split Type':

Write-up: States had generalized itching and ask for benedryl. 50mg Benedryl Tablet given PO after 10 minutes ask for Pepcid. After 15 minutes states he feels better and issues resolved


Changed on 5/14/2021

VAERS ID: 907032 Before After
VAERS Form:2
Age:63.0
Sex:Male
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 039K20A / UNK LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Pruritus

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Benedryl 50mg and Pepcid 20mg Tablet
Current Illness: none
Preexisting Conditions: High Blood Pressure
Allergies: no no
Diagnostic Lab Data: na
CDC 'Split Type':

Write-up: States had generalized itching and ask for benedryl. 50mg Benedryl Tablet given PO after 10 minutes ask for Pepcid. After 15 minutes states he feels better and issues resolved

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=907032&WAYBACKHISTORY=ON

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