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This is VAERS ID 908627

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 908627
VAERS Form:2
Age:44.0
Sex:Female
Location:Washington
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 037K20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Body temperature increased, Pruritus, Rash, Throat irritation, Ear pruritus

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: Depo Provera; Hydrocodone, steroid injection 12/21/20
Current Illness: Bicuspid Aortic valve, torn perineal longus tendon (R) Foot
Preexisting Conditions: see above
Allergies: Sulfa iodine, codeine, PCN, Metoprolol
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Appoximately 12:15pm patient Reporting itching all over her body, throat feeling scratchy, bumps forming on chest, ear itching. Vital signs taken Benedryl 12.5 mg given IM x2. pepcid given orally, continued to monitor x 60 min. Itching was Reduced over body, bumps on skin Resolved. Temperature Rose from 97.2F to 99.4F.


Changed on 5/7/2021

VAERS ID: 908627 Before After
VAERS Form:2
Age:44.0
Sex:Female
Location:Washington
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 037K20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Body temperature increased, Pruritus, Rash, Throat irritation, Ear pruritus

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: Depo Provera; Hydrocodone, steroid injection 12/21/20
Current Illness: Bicuspid Aortic valve, torn perineal longus tendon (R) Foot
Preexisting Conditions: see above
Allergies: Sulfa iodine, codeine, PCN, Metoprolol Metoprolol
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Appoximately 12:15pm patient Reporting itching all over her body, throat feeling scratchy, bumps forming on chest, ear itching. Vital signs taken Benedryl 12.5 mg given IM x2. pepcid given orally, continued to monitor x 60 min. Itching was Reduced over body, bumps on skin Resolved. Temperature Rose from 97.2F to 99.4F.


Changed on 5/21/2021

VAERS ID: 908627 Before After
VAERS Form:2
Age:44.0
Sex:Female
Location:Washington
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 037K20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Body temperature increased, Pruritus, Rash, Throat irritation, Ear pruritus

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: Depo Provera; Hydrocodone, steroid injection 12/21/20
Current Illness: Bicuspid Aortic valve, torn perineal longus tendon (R) Foot
Preexisting Conditions: see above
Allergies: Sulfa iodine, codeine, PCN, Metoprolol Metoprolol
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Appoximately 12:15pm patient Reporting itching all over her body, throat feeling scratchy, bumps forming on chest, ear itching. Vital signs taken Benedryl 12.5 mg given IM x2. pepcid given orally, continued to monitor x 60 min. Itching was Reduced over body, bumps on skin Resolved. Temperature Rose from 97.2F to 99.4F.

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