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This is VAERS ID 907081

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 907081
VAERS Form:2
Age:61.0
Sex:Female
Location:California
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 / UNK LA / IM

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

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: h/o reaction to allergy shot in the past, same feeling with on coming neck/face rash
Other Medications: prebiotic Allegra multi vitamin
Current Illness: none
Preexisting Conditions: cutaneous lupus Rheumatoid arthritis
Allergies: penicillin shellfish
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: 1600 Patient c/o itchiness to neck and face felt on coming rash 1625 notified me of reaction, advised to take Benadryl 50mg 1630 notified Pharmacist of reaction 1645 follow up with patient "doing okay" 1700 follow up call feeling the same not worse, leaving work for home, aware to go to ED if symptoms worsens


Changed on 5/7/2021

VAERS ID: 907081 Before After
VAERS Form:2
Age:61.0
Sex:Female
Location:California
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 / UNK LA / IM

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

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: h/o reaction to allergy shot in the past, same feeling with on coming neck/face rash
Other Medications: prebiotic Allegra multi vitamin
Current Illness: none
Preexisting Conditions: cutaneous lupus Rheumatoid arthritis
Allergies: penicillin shellfish shellfish
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: 1600 Patient c/o itchiness to neck and face felt on coming rash 1625 notified me of reaction, advised to take Benadryl 50mg 1630 notified Pharmacist of reaction 1645 follow up with patient "doing okay" 1700 follow up call feeling the same not worse, leaving work for home, aware to go to ED if symptoms worsens


Changed on 5/14/2021

VAERS ID: 907081 Before After
VAERS Form:2
Age:61.0
Sex:Female
Location:California
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 / UNK LA / IM

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

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: h/o reaction to allergy shot in the past, same feeling with on coming neck/face rash
Other Medications: prebiotic Allegra multi vitamin
Current Illness: none
Preexisting Conditions: cutaneous lupus Rheumatoid arthritis
Allergies: penicillin shellfish shellfish
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: 1600 Patient c/o itchiness to neck and face felt on coming rash 1625 notified me of reaction, advised to take Benadryl 50mg 1630 notified Pharmacist of reaction 1645 follow up with patient "doing okay" 1700 follow up call feeling the same not worse, leaving work for home, aware to go to ED if symptoms worsens

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=907081&WAYBACKHISTORY=ON

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