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This is VAERS ID 907098

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 907098
VAERS Form:2
Age:34.0
Sex:Female
Location:Unknown
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 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Chills, Injection site erythema, Pruritus

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received Moderna COVID vaccine at 1926. She completed standard 15 min observation time and was dismissed from clinic. Patient returned to clinic at 2000 with redness at injection site, itching, chills. BP 126/90 and pulse 86, patient able to speak comfortably. Diphenhydramine 25 mg given orally. Patient observed for 36 minutes. All symptoms resolved and observed redness to left deltoid completeely resolved. No complaints of shortness of breath or difficulty breathing. Patient discharged from clinic to another facility with appropriate follow up instructions. Patient texted ahead to her preceptor that she is en route.


Changed on 5/7/2021

VAERS ID: 907098 Before After
VAERS Form:2
Age:34.0
Sex:Female
Location:Unknown
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 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Chills, Injection site erythema, Pruritus

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received Moderna COVID vaccine at 1926. She completed standard 15 min observation time and was dismissed from clinic. Patient returned to clinic at 2000 with redness at injection site, itching, chills. BP 126/90 and pulse 86, patient able to speak comfortably. Diphenhydramine 25 mg given orally. Patient observed for 36 minutes. All symptoms resolved and observed redness to left deltoid completeely resolved. No complaints of shortness of breath or difficulty breathing. Patient discharged from clinic to another facility with appropriate follow up instructions. Patient texted ahead to her preceptor that she is en route.


Changed on 5/14/2021

VAERS ID: 907098 Before After
VAERS Form:2
Age:34.0
Sex:Female
Location:Unknown
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 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Chills, Injection site erythema, Pruritus

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received Moderna COVID vaccine at 1926. She completed standard 15 min observation time and was dismissed from clinic. Patient returned to clinic at 2000 with redness at injection site, itching, chills. BP 126/90 and pulse 86, patient able to speak comfortably. Diphenhydramine 25 mg given orally. Patient observed for 36 minutes. All symptoms resolved and observed redness to left deltoid completeely resolved. No complaints of shortness of breath or difficulty breathing. Patient discharged from clinic to another facility with appropriate follow up instructions. Patient texted ahead to her preceptor that she is en route.

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