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This is VAERS ID 908401

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 908401
VAERS Form:2
Age:24.0
Sex:Female
Location:Kentucky
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 011J20A / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: C-reactive protein increased, Chills, Dizziness, Electrocardiogram abnormal, Fibrin D dimer normal, Sinus tachycardia, Tremor

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)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Junel Birth Control
Current Illness: COVID-19 Positive with past 30 days, symptoms resolved
Preexisting Conditions: anxiety, heart murmur
Allergies: No known allergies
Diagnostic Lab Data: D-Dimer 0.64 C Reactive Protein 6.98 EKG- Sinus Tachycardia 146-160''s
CDC 'Split Type':

Write-up: Vaccine administered at 0730. Pt went home and went to bed. Woke up at 0930 with shaking, chills and feeling like she was going to pass out. Evaluated in ER and noted to have sinus tachycardia in 140-160''s. Given 5mg IV Lopressor which took heart rate down to 110''s. Admitted to hospital 12/23/2020.


Changed on 5/7/2021

VAERS ID: 908401 Before After
VAERS Form:2
Age:24.0
Sex:Female
Location:Kentucky
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 011J20A / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: C-reactive protein increased, Chills, Dizziness, Electrocardiogram abnormal, Fibrin D dimer normal, Sinus tachycardia, Tremor

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)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Junel Birth Control
Current Illness: COVID-19 Positive with past 30 days, symptoms resolved
Preexisting Conditions: anxiety, heart murmur
Allergies: No known allergies allergies
Diagnostic Lab Data: D-Dimer 0.64 C Reactive Protein 6.98 EKG- Sinus Tachycardia 146-160''s
CDC 'Split Type':

Write-up: Vaccine administered at 0730. Pt went home and went to bed. Woke up at 0930 with shaking, chills and feeling like she was going to pass out. Evaluated in ER and noted to have sinus tachycardia in 140-160''s. Given 5mg IV Lopressor which took heart rate down to 110''s. Admitted to hospital 12/23/2020.


Changed on 5/14/2021

VAERS ID: 908401 Before After
VAERS Form:2
Age:24.0
Sex:Female
Location:Kentucky
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 011J20A / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: C-reactive protein increased, Chills, Dizziness, Electrocardiogram abnormal, Fibrin D dimer normal, Sinus tachycardia, Tremor

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)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Junel Birth Control
Current Illness: COVID-19 Positive with past 30 days, symptoms resolved
Preexisting Conditions: anxiety, heart murmur
Allergies: No known allergies allergies
Diagnostic Lab Data: D-Dimer 0.64 C Reactive Protein 6.98 EKG- Sinus Tachycardia 146-160''s
CDC 'Split Type':

Write-up: Vaccine administered at 0730. Pt went home and went to bed. Woke up at 0930 with shaking, chills and feeling like she was going to pass out. Evaluated in ER and noted to have sinus tachycardia in 140-160''s. Given 5mg IV Lopressor which took heart rate down to 110''s. Admitted to hospital 12/23/2020.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=908401&WAYBACKHISTORY=ON

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