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This is VAERS ID 907472

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 907472
VAERS Form:2
Age:34.0
Sex:Female
Location:California
Vaccinated:2020-12-22
Onset:2020-12-22
Submitted:0000-00-00
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20H / 1 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Injection site induration, Injection site pain, Injection site reaction, Injection site swelling

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: None
Current Illness: None
Preexisting Conditions: Type 2 Diabetes
Allergies: None
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Redness, pain, swelling hardness injection site Ice/Cold compress, Ibuprofen


Changed on 5/7/2021

VAERS ID: 907472 Before After
VAERS Form:2
Age:34.0
Sex:Female
Location:California
Vaccinated:2020-12-22
Onset:2020-12-22
Submitted:0000-00-00
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20H / 1 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Injection site induration, Injection site pain, Injection site reaction, Injection site swelling

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: None
Current Illness: None
Preexisting Conditions: Type 2 Diabetes
Allergies: None None
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Redness, pain, swelling hardness injection site Ice/Cold compress, Ibuprofen


Changed on 5/14/2021

VAERS ID: 907472 Before After
VAERS Form:2
Age:34.0
Sex:Female
Location:California
Vaccinated:2020-12-22
Onset:2020-12-22
Submitted:0000-00-00
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20H / 1 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Injection site induration, Injection site pain, Injection site reaction, Injection site swelling

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: None
Current Illness: None
Preexisting Conditions: Type 2 Diabetes
Allergies: None None
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Redness, pain, swelling hardness injection site Ice/Cold compress, Ibuprofen

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