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This is VAERS ID 907486

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 907486
VAERS Form:2
Age:42.0
Sex:Female
Location:South Dakota
Vaccinated:2020-12-22
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Headache, Injection site pain

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: n/a
Preexisting Conditions: n/a
Allergies: NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: headache, injection site arm pain


Changed on 5/7/2021

VAERS ID: 907486 Before After
VAERS Form:2
Age:42.0
Sex:Female
Location:South Dakota
Vaccinated:2020-12-22
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Headache, Injection site pain

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: n/a
Preexisting Conditions: n/a
Allergies: NKA NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: headache, injection site arm pain


Changed on 5/14/2021

VAERS ID: 907486 Before After
VAERS Form:2
Age:42.0
Sex:Female
Location:South Dakota
Vaccinated:2020-12-22
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Headache, Injection site pain

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: n/a
Preexisting Conditions: n/a
Allergies: NKA NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: headache, injection site arm pain

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=907486&WAYBACKHISTORY=ON


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