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This is VAERS ID 907131

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 907131
VAERS Form:2
Age:50.0
Sex:Female
Location:Iowa
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 025J20-2A / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Palpitations, Pharyngeal swelling

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin, Alprazolam (as needed), Loratadine, Omeprazole, Vitamin D, Calcium, Multivitamin
Current Illness: None known
Preexisting Conditions:
Allergies: Morphine, Strawberries, Prochlorperazine, Septra, Penicllin, Levaquin, Ciprofloxacin, Cephalexin, Ceftriaxone
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: About 10-15 minutes after receiving vaccine patient reported that her heart began to race and throat began to swell.


Changed on 5/7/2021

VAERS ID: 907131 Before After
VAERS Form:2
Age:50.0
Sex:Female
Location:Iowa
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 025J20-2A / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Palpitations, Pharyngeal swelling

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin, Alprazolam (as needed), Loratadine, Omeprazole, Vitamin D, Calcium, Multivitamin
Current Illness: None known
Preexisting Conditions:
Allergies: Morphine, Strawberries, Prochlorperazine, Septra, Penicllin, Levaquin, Ciprofloxacin, Cephalexin, Ceftriaxone Ceftriaxone
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: About 10-15 minutes after receiving vaccine patient reported that her heart began to race and throat began to swell.


Changed on 5/14/2021

VAERS ID: 907131 Before After
VAERS Form:2
Age:50.0
Sex:Female
Location:Iowa
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 025J20-2A / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Palpitations, Pharyngeal swelling

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin, Alprazolam (as needed), Loratadine, Omeprazole, Vitamin D, Calcium, Multivitamin
Current Illness: None known
Preexisting Conditions:
Allergies: Morphine, Strawberries, Prochlorperazine, Septra, Penicllin, Levaquin, Ciprofloxacin, Cephalexin, Ceftriaxone Ceftriaxone
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: About 10-15 minutes after receiving vaccine patient reported that her heart began to race and throat began to swell.

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