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This is VAERS ID 907738

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 907738
VAERS Form:2
Age:62.0
Sex:Female
Location:Connecticut
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 011J20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Ear swelling, Erythema, Lip swelling, Pharyngeal erythema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: protonix, rosuvastatin
Current Illness:
Preexisting Conditions:
Allergies: Fiorinal - shortness of breath iodinated diagnostic agents - anaphylaxis Meperidine - shortness of breath latex - rash penicillins - rash tetracycline - rash
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Approximately 35 minutes after patient received the vaccine, she noted redness around her chest and neck, goin up to her face and both ears. Ears were swollen. She was transferred to the ED for evaluation, where it was noted that she had redness of her throat and chest with slight swelling of her lips. In the ED, she was given prednisone 40mg PO and famotidine 40mg PO. She was observed and discharged after ~90 minutes.


Changed on 5/7/2021

VAERS ID: 907738 Before After
VAERS Form:2
Age:62.0
Sex:Female
Location:Connecticut
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 011J20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Ear swelling, Erythema, Lip swelling, Pharyngeal erythema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: protonix, rosuvastatin
Current Illness:
Preexisting Conditions:
Allergies: Fiorinal - shortness of breath iodinated diagnostic agents - anaphylaxis Meperidine - shortness of breath latex - rash penicillins - rash tetracycline - rash rash
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Approximately 35 minutes after patient received the vaccine, she noted redness around her chest and neck, goin up to her face and both ears. Ears were swollen. She was transferred to the ED for evaluation, where it was noted that she had redness of her throat and chest with slight swelling of her lips. In the ED, she was given prednisone 40mg PO and famotidine 40mg PO. She was observed and discharged after ~90 minutes.


Changed on 5/14/2021

VAERS ID: 907738 Before After
VAERS Form:2
Age:62.0
Sex:Female
Location:Connecticut
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 011J20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Ear swelling, Erythema, Lip swelling, Pharyngeal erythema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: protonix, rosuvastatin
Current Illness:
Preexisting Conditions:
Allergies: Fiorinal - shortness of breath iodinated diagnostic agents - anaphylaxis Meperidine - shortness of breath latex - rash penicillins - rash tetracycline - rash rash
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Approximately 35 minutes after patient received the vaccine, she noted redness around her chest and neck, goin up to her face and both ears. Ears were swollen. She was transferred to the ED for evaluation, where it was noted that she had redness of her throat and chest with slight swelling of her lips. In the ED, she was given prednisone 40mg PO and famotidine 40mg PO. She was observed and discharged after ~90 minutes.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=907738&WAYBACKHISTORY=ON


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