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This is VAERS ID 908368

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 908368
VAERS Form:2
Age:42.0
Sex:Female
Location:Ohio
Vaccinated:2020-12-23
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Chills, Fatigue, Injection site induration, Lip 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: None
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Moderna COVID 19 vaccine eua, lip swelling approximately 12 hours after injection, chills, fatigue and hardness at injection site approximately 10 hrs after injection


Changed on 5/7/2021

VAERS ID: 908368 Before After
VAERS Form:2
Age:42.0
Sex:Female
Location:Ohio
Vaccinated:2020-12-23
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Chills, Fatigue, Injection site induration, Lip 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: None
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Moderna COVID 19 vaccine eua, lip swelling approximately 12 hours after injection, chills, fatigue and hardness at injection site approximately 10 hrs after injection


Changed on 5/14/2021

VAERS ID: 908368 Before After
VAERS Form:2
Age:42.0
Sex:Female
Location:Ohio
Vaccinated:2020-12-23
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Chills, Fatigue, Injection site induration, Lip 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: None
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Moderna COVID 19 vaccine eua, lip swelling approximately 12 hours after injection, chills, fatigue and hardness at injection site approximately 10 hrs after injection

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=908368&WAYBACKHISTORY=ON

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