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This is VAERS ID 907058

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 907058
VAERS Form:2
Age:33.0
Sex:Female
Location:Alaska
Vaccinated:2020-12-21
Onset:2020-12-21
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: Military      Purchased by: ??
Symptoms: Swollen tongue, Throat irritation

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: none
Current Illness: cold x3weeks ago. negative for covid.
Preexisting Conditions: Fibromyalgia benign hypermobility syndrome
Allergies: opioids- nausea/vomiting Phenergan - skin/ itchiness
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: itchiness in throat, mild tongue swelling. Administered Benadryl 50 mg. sx resolved 5-6 minutes after medication administered


Changed on 5/7/2021

VAERS ID: 907058 Before After
VAERS Form:2
Age:33.0
Sex:Female
Location:Alaska
Vaccinated:2020-12-21
Onset:2020-12-21
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: Military      Purchased by: ??
Symptoms: Swollen tongue, Throat irritation

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: none
Current Illness: cold x3weeks ago. negative for covid.
Preexisting Conditions: Fibromyalgia benign hypermobility syndrome
Allergies: opioids- nausea/vomiting Phenergan - skin/ itchiness itchiness
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: itchiness in throat, mild tongue swelling. Administered Benadryl 50 mg. sx resolved 5-6 minutes after medication administered


Changed on 5/14/2021

VAERS ID: 907058 Before After
VAERS Form:2
Age:33.0
Sex:Female
Location:Alaska
Vaccinated:2020-12-21
Onset:2020-12-21
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: Military      Purchased by: ??
Symptoms: Swollen tongue, Throat irritation

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: none
Current Illness: cold x3weeks ago. negative for covid.
Preexisting Conditions: Fibromyalgia benign hypermobility syndrome
Allergies: opioids- nausea/vomiting Phenergan - skin/ itchiness itchiness
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: itchiness in throat, mild tongue swelling. Administered Benadryl 50 mg. sx resolved 5-6 minutes after medication administered

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=907058&WAYBACKHISTORY=ON

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