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This is VAERS ID 908629

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 908629
VAERS Form:2
Age:50.0
Sex:Female
Location:Nebraska
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 025I20-2A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Hypersensitivity, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Vitamin D3, Reglan, Nortriptyline, Topamax, Potassium Chloride, Topomax, Crestor, Aimovig autominjector, Ubrelvy, Verapamil, Valacyclovir, Cardizem
Current Illness:
Preexisting Conditions: Migraine disorder, sinus tachycardia, familial combined hyperlipidemia
Allergies: Latex allergy
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Urticaria, allergic reaction to COVID-19 vaccine, treatment with famotidine and benadryl, along with prednisone for 5 days.


Changed on 5/7/2021

VAERS ID: 908629 Before After
VAERS Form:2
Age:50.0
Sex:Female
Location:Nebraska
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 025I20-2A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Hypersensitivity, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Vitamin D3, Reglan, Nortriptyline, Topamax, Potassium Chloride, Topomax, Crestor, Aimovig autominjector, Ubrelvy, Verapamil, Valacyclovir, Cardizem
Current Illness:
Preexisting Conditions: Migraine disorder, sinus tachycardia, familial combined hyperlipidemia
Allergies: Latex allergy allergy
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Urticaria, allergic reaction to COVID-19 vaccine, treatment with famotidine and benadryl, along with prednisone for 5 days.


Changed on 5/14/2021

VAERS ID: 908629 Before After
VAERS Form:2
Age:50.0
Sex:Female
Location:Nebraska
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 025I20-2A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Hypersensitivity, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Vitamin D3, Reglan, Nortriptyline, Topamax, Potassium Chloride, Topomax, Crestor, Aimovig autominjector, Ubrelvy, Verapamil, Valacyclovir, Cardizem
Current Illness:
Preexisting Conditions: Migraine disorder, sinus tachycardia, familial combined hyperlipidemia
Allergies: Latex allergy allergy
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Urticaria, allergic reaction to COVID-19 vaccine, treatment with famotidine and benadryl, along with prednisone for 5 days.

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