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This is VAERS ID 907330

History of Changes from the VAERS Wayback Machine

First Appeared on 12/24/2020

VAERS ID: 907330
VAERS Form:2
Age:50.0
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 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Abdominal discomfort, Abdominal pain, Dizziness, Dyspnoea, Headache, Hyperhidrosis, Hyperventilation, Rash macular, 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Flexeril, Advil, Protonix, Estrace, Vivelle DOT Norco PRN
Current Illness: No
Preexisting Conditions: Mild Osteopenia, GERD, Anemia,
Allergies: Reglan - anaphylaxis
Diagnostic Lab Data: 12/22 ED administrated PEPCID, ZOFRAN, Prednisone 60 mg, and Ativan 1mg IV.
CDC 'Split Type':

Write-up: Employee presented to COVID Clinic for Moderna COVID 19 vaccination 1st dose. Given to left arm. Left clinic prior to completing 15 minute observation time and told an MA in waiting area that she felt ill ot her stomach and having trouble taking deep breaths. Employee found in nearby Bathroom sitting on the floor, she had vomited, reported she was lightheaded, couldn''t breath, shaking, abdominal discomfort sweating, attempted to move employee to wheelchair, did respond well to transfer to Wheelchair, She reported symptoms worsening: HA, abdominal pain and developed blotchy skin, hyperventilating, and dizzy. CODE Blue called, patient given Epinephrine injection 0.5mg patient sent to ER


Changed on 12/30/2020

VAERS ID: 907330 Before After
VAERS Form:2
Age:50.0
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 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Abdominal discomfort, Abdominal pain, Dizziness, Dyspnoea, Headache, Hyperhidrosis, Hyperventilation, Rash macular, 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Flexeril, Advil, Protonix, Estrace, Vivelle DOT Norco PRN
Current Illness: No
Preexisting Conditions: Mild Osteopenia, GERD, Anemia,
Allergies: Reglan - anaphylaxis anaphylaxis
Diagnostic Lab Data: 12/22 ED administrated PEPCID, ZOFRAN, Prednisone 60 mg, and Ativan 1mg IV.
CDC 'Split Type':

Write-up: Employee presented to COVID Clinic for Moderna COVID 19 vaccination 1st dose. Given to left arm. Left clinic prior to completing 15 minute observation time and told an MA in waiting area that she felt ill ot her stomach and having trouble taking deep breaths. Employee found in nearby Bathroom sitting on the floor, she had vomited, reported she was lightheaded, couldn''t breath, shaking, abdominal discomfort sweating, attempted to move employee to wheelchair, did respond well to transfer to Wheelchair, She reported symptoms worsening: HA, abdominal pain and developed blotchy skin, hyperventilating, and dizzy. CODE Blue called, patient given Epinephrine injection 0.5mg patient sent to ER


Changed on 5/7/2021

VAERS ID: 907330 Before After
VAERS Form:2
Age:50.0
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 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Abdominal discomfort, Abdominal pain, Dizziness, Dyspnoea, Headache, Hyperhidrosis, Hyperventilation, Rash macular, 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Flexeril, Advil, Protonix, Estrace, Vivelle DOT Norco PRN
Current Illness: No
Preexisting Conditions: Mild Osteopenia, GERD, Anemia,
Allergies: Reglan - anaphylaxis anaphylaxis
Diagnostic Lab Data: 12/22 ED administrated PEPCID, ZOFRAN, Prednisone 60 mg, and Ativan 1mg IV.
CDC 'Split Type':

Write-up: Employee presented to COVID Clinic for Moderna COVID 19 vaccination 1st dose. Given to left arm. Left clinic prior to completing 15 minute observation time and told an MA in waiting area that she felt ill ot her stomach and having trouble taking deep breaths. Employee found in nearby Bathroom sitting on the floor, she had vomited, reported she was lightheaded, couldn''t breath, shaking, abdominal discomfort sweating, attempted to move employee to wheelchair, did respond well to transfer to Wheelchair, She reported symptoms worsening: HA, abdominal pain and developed blotchy skin, hyperventilating, and dizzy. CODE Blue called, patient given Epinephrine injection 0.5mg patient sent to ER


Changed on 5/14/2021

VAERS ID: 907330 Before After
VAERS Form:2
Age:50.0
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 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Abdominal discomfort, Abdominal pain, Dizziness, Dyspnoea, Headache, Hyperhidrosis, Hyperventilation, Rash macular, 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Flexeril, Advil, Protonix, Estrace, Vivelle DOT Norco PRN
Current Illness: No
Preexisting Conditions: Mild Osteopenia, GERD, Anemia,
Allergies: Reglan - anaphylaxis anaphylaxis
Diagnostic Lab Data: 12/22 ED administrated PEPCID, ZOFRAN, Prednisone 60 mg, and Ativan 1mg IV.
CDC 'Split Type':

Write-up: Employee presented to COVID Clinic for Moderna COVID 19 vaccination 1st dose. Given to left arm. Left clinic prior to completing 15 minute observation time and told an MA in waiting area that she felt ill ot her stomach and having trouble taking deep breaths. Employee found in nearby Bathroom sitting on the floor, she had vomited, reported she was lightheaded, couldn''t breath, shaking, abdominal discomfort sweating, attempted to move employee to wheelchair, did respond well to transfer to Wheelchair, She reported symptoms worsening: HA, abdominal pain and developed blotchy skin, hyperventilating, and dizzy. CODE Blue called, patient given Epinephrine injection 0.5mg patient sent to ER

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