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This is VAERS ID 909355

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 909355
VAERS Form:2
Age:42.0
Sex:Female
Location:Iowa
Vaccinated:2020-12-26
Onset:2020-12-26
Submitted:0000-00-00
Entered:2020-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Anxiety, Dizziness, Dyspnoea, Feeling abnormal, Nervousness, Pallor, Palpitations

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: asthma, seasonal allergies, pericardial cyst
Allergies: none
Diagnostic Lab Data: No labs reported in EHR at this time. Per provider notes, positive for palpitations, light headedness, and nervous/anxious. Discharged to home.
CDC 'Split Type':

Write-up: several minutes after vaccination, complained of shortness of breath. Nurse used standing order protocol to administer epi 0.3 mg into right deltoid. Patient reports feeling a little better BEFORE the epi, but reported feeling "strange". Charge nurse notified the emergency department, an ED nurse advised coming for workup in the ED (which is right down the hallway). Patient walked to ED. Appeared pale. Patient discharged from the ED with a prescription for zyrtec.


Changed on 5/7/2021

VAERS ID: 909355 Before After
VAERS Form:2
Age:42.0
Sex:Female
Location:Iowa
Vaccinated:2020-12-26
Onset:2020-12-26
Submitted:0000-00-00
Entered:2020-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Anxiety, Dizziness, Dyspnoea, Feeling abnormal, Nervousness, Pallor, Palpitations

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: asthma, seasonal allergies, pericardial cyst
Allergies: none none
Diagnostic Lab Data: No labs reported in EHR at this time. Per provider notes, positive for palpitations, light headedness, and nervous/anxious. Discharged to home.
CDC 'Split Type':

Write-up: several minutes after vaccination, complained of shortness of breath. Nurse used standing order protocol to administer epi 0.3 mg into right deltoid. Patient reports feeling a little better BEFORE the epi, but reported feeling "strange". Charge nurse notified the emergency department, an ED nurse advised coming for workup in the ED (which is right down the hallway). Patient walked to ED. Appeared pale. Patient discharged from the ED with a prescription for zyrtec.


Changed on 5/21/2021

VAERS ID: 909355 Before After
VAERS Form:2
Age:42.0
Sex:Female
Location:Iowa
Vaccinated:2020-12-26
Onset:2020-12-26
Submitted:0000-00-00
Entered:2020-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Anxiety, Dizziness, Dyspnoea, Feeling abnormal, Nervousness, Pallor, Palpitations

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: asthma, seasonal allergies, pericardial cyst
Allergies: none none
Diagnostic Lab Data: No labs reported in EHR at this time. Per provider notes, positive for palpitations, light headedness, and nervous/anxious. Discharged to home.
CDC 'Split Type':

Write-up: several minutes after vaccination, complained of shortness of breath. Nurse used standing order protocol to administer epi 0.3 mg into right deltoid. Patient reports feeling a little better BEFORE the epi, but reported feeling "strange". Charge nurse notified the emergency department, an ED nurse advised coming for workup in the ED (which is right down the hallway). Patient walked to ED. Appeared pale. Patient discharged from the ED with a prescription for zyrtec.

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