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This is VAERS ID 908647

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 908647
VAERS Form:2
Age:34.0
Sex:Female
Location:North Dakota
Vaccinated:2020-12-22
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 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Injection site erythema, Injection site warmth, Rash, Urticaria, Injection site 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: Levothyroxin 25mcg, Vit D 10,000 iu, Zyrtec 10 mg.
Current Illness:
Preexisting Conditions: Hashimoto?s
Allergies: Erythromycin, penicillin, sulfa
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt(I) report swelling, redness, and warmth at the injection site was first noticed in the morning at 6:30 am on 12/24/2020 currently 2.5 inches by 1 5/8 inches. Pt has history of hives. Hive type rash noted on inside of right arm. Hive do not itch.


Changed on 5/7/2021

VAERS ID: 908647 Before After
VAERS Form:2
Age:34.0
Sex:Female
Location:North Dakota
Vaccinated:2020-12-22
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 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Injection site erythema, Injection site warmth, Rash, Urticaria, Injection site 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: Levothyroxin 25mcg, Vit D 10,000 iu, Zyrtec 10 mg.
Current Illness:
Preexisting Conditions: Hashimoto?s
Allergies: Erythromycin, penicillin, sulfa sulfa
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt(I) report swelling, redness, and warmth at the injection site was first noticed in the morning at 6:30 am on 12/24/2020 currently 2.5 inches by 1 5/8 inches. Pt has history of hives. Hive type rash noted on inside of right arm. Hive do not itch.


Changed on 5/14/2021

VAERS ID: 908647 Before After
VAERS Form:2
Age:34.0
Sex:Female
Location:North Dakota
Vaccinated:2020-12-22
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 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Injection site erythema, Injection site warmth, Rash, Urticaria, Injection site 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: Levothyroxin 25mcg, Vit D 10,000 iu, Zyrtec 10 mg.
Current Illness:
Preexisting Conditions: Hashimoto?s
Allergies: Erythromycin, penicillin, sulfa sulfa
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt(I) report swelling, redness, and warmth at the injection site was first noticed in the morning at 6:30 am on 12/24/2020 currently 2.5 inches by 1 5/8 inches. Pt has history of hives. Hive type rash noted on inside of right arm. Hive do not itch.

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