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This is VAERS ID 908534

History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 908534
VAERS Form:2
Age:30.0
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 011J20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Flushing, Lacrimation increased, Ocular hyperaemia, Pruritus, Urticaria, Eye pruritus

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: mirtazapine 25mg QHS
Current Illness: none
Preexisting Conditions: none
Allergies: Zofran, Bee stings
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient started with watery red eyes and face was flushed. initial vital signs after notice of reaction was Bp 120/88 then noticed mild hives on neck and behind ears. Decided to give patient Benedryl 50 mg IM in Right Deltoid at 1:12pm and retook vitals at 1:20 Bp 118/74 pulse 86 and SAO2 99% on room air. Vitals at 1:36 pm were BP 116/84 pulse 90 and SAO2 97% on room air. Redness and eye watering and itching improved. Spoke with patient again today she says she still has a slight itchiness between fingers and will consult physician prior to second dose.


Changed on 5/7/2021

VAERS ID: 908534 Before After
VAERS Form:2
Age:30.0
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 011J20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Flushing, Lacrimation increased, Ocular hyperaemia, Pruritus, Urticaria, Eye pruritus

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: mirtazapine 25mg QHS
Current Illness: none
Preexisting Conditions: none
Allergies: Zofran, Bee stings stings
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient started with watery red eyes and face was flushed. initial vital signs after notice of reaction was Bp 120/88 then noticed mild hives on neck and behind ears. Decided to give patient Benedryl 50 mg IM in Right Deltoid at 1:12pm and retook vitals at 1:20 Bp 118/74 pulse 86 and SAO2 99% on room air. Vitals at 1:36 pm were BP 116/84 pulse 90 and SAO2 97% on room air. Redness and eye watering and itching improved. Spoke with patient again today she says she still has a slight itchiness between fingers and will consult physician prior to second dose.


Changed on 5/14/2021

VAERS ID: 908534 Before After
VAERS Form:2
Age:30.0
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 011J20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Flushing, Lacrimation increased, Ocular hyperaemia, Pruritus, Urticaria, Eye pruritus

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: mirtazapine 25mg QHS
Current Illness: none
Preexisting Conditions: none
Allergies: Zofran, Bee stings stings
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient started with watery red eyes and face was flushed. initial vital signs after notice of reaction was Bp 120/88 then noticed mild hives on neck and behind ears. Decided to give patient Benedryl 50 mg IM in Right Deltoid at 1:12pm and retook vitals at 1:20 Bp 118/74 pulse 86 and SAO2 99% on room air. Vitals at 1:36 pm were BP 116/84 pulse 90 and SAO2 97% on room air. Redness and eye watering and itching improved. Spoke with patient again today she says she still has a slight itchiness between fingers and will consult physician prior to second dose.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=908534&WAYBACKHISTORY=ON

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