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This is VAERS ID 907811

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 907811
VAERS Form:2
Age:41.0
Sex:Female
Location:Iowa
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 / 1 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Pruritus, Rash macular

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertaline 50mg
Current Illness: none
Preexisting Conditions: none
Allergies: morphine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Itchy blotchy spots, left arm, left ear, back


Changed on 5/7/2021

VAERS ID: 907811 Before After
VAERS Form:2
Age:41.0
Sex:Female
Location:Iowa
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 / 1 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Pruritus, Rash macular

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertaline 50mg
Current Illness: none
Preexisting Conditions: none
Allergies: morphine morphine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Itchy blotchy spots, left arm, left ear, back


Changed on 5/14/2021

VAERS ID: 907811 Before After
VAERS Form:2
Age:41.0
Sex:Female
Location:Iowa
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 / 1 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Pruritus, Rash macular

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertaline 50mg
Current Illness: none
Preexisting Conditions: none
Allergies: morphine morphine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Itchy blotchy spots, left arm, left ear, back

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=907811&WAYBACKHISTORY=ON


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