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This is VAERS ID 907448

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 907448
VAERS Form:2
Age:25.0
Sex:Female
Location:Tennessee
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 025J20-2A / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Dizziness, 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: Pt stated experiencing the onset of itching in her left arm and face after receiving the Covid vaccine in her left arm. Pt also stated experiencing a mild episode of feeling light headed after the administration of Covid vaccine. No Redness, Swelling, or Rash at injection site or on face. 25mg Benedryl administered p.o. at 9:21am.


Changed on 5/7/2021

VAERS ID: 907448 Before After
VAERS Form:2
Age:25.0
Sex:Female
Location:Tennessee
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 025J20-2A / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Dizziness, 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: Pt stated experiencing the onset of itching in her left arm and face after receiving the Covid vaccine in her left arm. Pt also stated experiencing a mild episode of feeling light headed after the administration of Covid vaccine. No Redness, Swelling, or Rash at injection site or on face. 25mg Benedryl administered p.o. at 9:21am.


Changed on 5/21/2021

VAERS ID: 907448 Before After
VAERS Form:2
Age:25.0
Sex:Female
Location:Tennessee
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 025J20-2A / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Dizziness, 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: Pt stated experiencing the onset of itching in her left arm and face after receiving the Covid vaccine in her left arm. Pt also stated experiencing a mild episode of feeling light headed after the administration of Covid vaccine. No Redness, Swelling, or Rash at injection site or on face. 25mg Benedryl administered p.o. at 9:21am.

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