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This is VAERS ID 907254

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 907254
VAERS Form:2
Age:32.0
Sex:Female
Location:Connecticut
Vaccinated:2020-12-23
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Erythema, Injection site pruritus, Rash, Urticaria

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: Flu vaccine Flucelvax
Other Medications: Benadryl 50 mg po prior to vaccine
Current Illness: none
Preexisting Conditions: Thyroid disease Migraine Allergic rhinitis GERD (gastroesophageal reflux disease) Visual impairment
Allergies: Amoxicillin Penicillin Cefzil food and nut
Diagnostic Lab Data: Solumedrol 125 IM Pepcid 20 mg po
CDC 'Split Type':

Write-up: Approx 10 min after receiving vaccine- patient developed rash and hives on neck and chest with complaints of itchiness on R arm at vaccine site. Also developed redness to right ear. no respiratory difficulties noted. Patient transported to ED for further evaluation and treatment


Changed on 5/7/2021

VAERS ID: 907254 Before After
VAERS Form:2
Age:32.0
Sex:Female
Location:Connecticut
Vaccinated:2020-12-23
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Erythema, Injection site pruritus, Rash, Urticaria

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: Flu vaccine Flucelvax
Other Medications: Benadryl 50 mg po prior to vaccine
Current Illness: none
Preexisting Conditions: Thyroid disease Migraine Allergic rhinitis GERD (gastroesophageal reflux disease) Visual impairment
Allergies: Amoxicillin Penicillin Cefzil food and nut nut
Diagnostic Lab Data: Solumedrol 125 IM Pepcid 20 mg po
CDC 'Split Type':

Write-up: Approx 10 min after receiving vaccine- patient developed rash and hives on neck and chest with complaints of itchiness on R arm at vaccine site. Also developed redness to right ear. no respiratory difficulties noted. Patient transported to ED for further evaluation and treatment


Changed on 5/14/2021

VAERS ID: 907254 Before After
VAERS Form:2
Age:32.0
Sex:Female
Location:Connecticut
Vaccinated:2020-12-23
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Erythema, Injection site pruritus, Rash, Urticaria

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: Flu vaccine Flucelvax
Other Medications: Benadryl 50 mg po prior to vaccine
Current Illness: none
Preexisting Conditions: Thyroid disease Migraine Allergic rhinitis GERD (gastroesophageal reflux disease) Visual impairment
Allergies: Amoxicillin Penicillin Cefzil food and nut nut
Diagnostic Lab Data: Solumedrol 125 IM Pepcid 20 mg po
CDC 'Split Type':

Write-up: Approx 10 min after receiving vaccine- patient developed rash and hives on neck and chest with complaints of itchiness on R arm at vaccine site. Also developed redness to right ear. no respiratory difficulties noted. Patient transported to ED for further evaluation and treatment

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