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This is VAERS ID 907329

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 907329
VAERS Form:2
Age:35.0
Sex:Female
Location:Arizona
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 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Abdominal discomfort, Dizziness, Dyspnoea, Hypoaesthesia, Tremor, Vomiting

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Meloxicam
Current Illness: Obesity Gastric Sleeve
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: 12/22 ED administrated Lactated Ringers, Decadron 10mg, PEPCID, ZOFRAN,
CDC 'Split Type':

Write-up: Employee presented to COVID Clinic for Moderna COVID 19 vaccination 1st dose. Given to right arm. Left clinic after waiting 15 minute observation time. She returned to work and returned about 45 minutes reporting she was having difficulty taking deep breaths, numbness to bilateral extremities, abdominal discomfort and lightheaded, NO rash or hives noted. VSS stable A&O, Within a few minutes employee started vomiting, shaking, and C/O of severe abdominal discomfort, Epinephrine injection 0.5mg given to left arm. Employee transported to ED.


Changed on 5/7/2021

VAERS ID: 907329 Before After
VAERS Form:2
Age:35.0
Sex:Female
Location:Arizona
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 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Abdominal discomfort, Dizziness, Dyspnoea, Hypoaesthesia, Tremor, Vomiting

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Meloxicam
Current Illness: Obesity Gastric Sleeve
Preexisting Conditions: None
Allergies: NKA NKA
Diagnostic Lab Data: 12/22 ED administrated Lactated Ringers, Decadron 10mg, PEPCID, ZOFRAN,
CDC 'Split Type':

Write-up: Employee presented to COVID Clinic for Moderna COVID 19 vaccination 1st dose. Given to right arm. Left clinic after waiting 15 minute observation time. She returned to work and returned about 45 minutes reporting she was having difficulty taking deep breaths, numbness to bilateral extremities, abdominal discomfort and lightheaded, NO rash or hives noted. VSS stable A&O, Within a few minutes employee started vomiting, shaking, and C/O of severe abdominal discomfort, Epinephrine injection 0.5mg given to left arm. Employee transported to ED.


Changed on 5/14/2021

VAERS ID: 907329 Before After
VAERS Form:2
Age:35.0
Sex:Female
Location:Arizona
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 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Abdominal discomfort, Dizziness, Dyspnoea, Hypoaesthesia, Tremor, Vomiting

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Meloxicam
Current Illness: Obesity Gastric Sleeve
Preexisting Conditions: None
Allergies: NKA NKA
Diagnostic Lab Data: 12/22 ED administrated Lactated Ringers, Decadron 10mg, PEPCID, ZOFRAN,
CDC 'Split Type':

Write-up: Employee presented to COVID Clinic for Moderna COVID 19 vaccination 1st dose. Given to right arm. Left clinic after waiting 15 minute observation time. She returned to work and returned about 45 minutes reporting she was having difficulty taking deep breaths, numbness to bilateral extremities, abdominal discomfort and lightheaded, NO rash or hives noted. VSS stable A&O, Within a few minutes employee started vomiting, shaking, and C/O of severe abdominal discomfort, Epinephrine injection 0.5mg given to left arm. Employee transported to ED.

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