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This is VAERS ID 909061

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 909061
VAERS Form:2
Age:66.0
Sex:Female
Location:Ohio
Vaccinated:2020-12-24
Onset:2020-12-24
Submitted:0000-00-00
Entered:2020-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA G39K20-2A / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood pressure increased, Swollen tongue

Life Threatening? Yes
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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor, Maxide-25, Cymbalta, ASA
Current Illness:
Preexisting Conditions: hypertension
Allergies: Codeine, PCN, Promethazine, sulfa antibiotics
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Reported sensation of tongue swelling during post-vaccination observation at 10 minutes. Epinephrine was refused and she was taken to ED for observation where she was given oral dose of Benadryl and Pepcid. Discharged with instructions to return PRN and follow up with PCP. Elevated BP noted.


Changed on 5/7/2021

VAERS ID: 909061 Before After
VAERS Form:2
Age:66.0
Sex:Female
Location:Ohio
Vaccinated:2020-12-24
Onset:2020-12-24
Submitted:0000-00-00
Entered:2020-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA G39K20-2A / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood pressure increased, Swollen tongue

Life Threatening? Yes
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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor, Maxide-25, Cymbalta, ASA
Current Illness:
Preexisting Conditions: hypertension
Allergies: Codeine, PCN, Promethazine, sulfa antibiotics antibiotics
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Reported sensation of tongue swelling during post-vaccination observation at 10 minutes. Epinephrine was refused and she was taken to ED for observation where she was given oral dose of Benadryl and Pepcid. Discharged with instructions to return PRN and follow up with PCP. Elevated BP noted.


Changed on 5/14/2021

VAERS ID: 909061 Before After
VAERS Form:2
Age:66.0
Sex:Female
Location:Ohio
Vaccinated:2020-12-24
Onset:2020-12-24
Submitted:0000-00-00
Entered:2020-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA G39K20-2A / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood pressure increased, Swollen tongue

Life Threatening? Yes
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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor, Maxide-25, Cymbalta, ASA
Current Illness:
Preexisting Conditions: hypertension
Allergies: Codeine, PCN, Promethazine, sulfa antibiotics antibiotics
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Reported sensation of tongue swelling during post-vaccination observation at 10 minutes. Epinephrine was refused and she was taken to ED for observation where she was given oral dose of Benadryl and Pepcid. Discharged with instructions to return PRN and follow up with PCP. Elevated BP noted.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=909061&WAYBACKHISTORY=ON

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