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This is VAERS ID 909447

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 909447
VAERS Form:2
Age:42.0
Sex:Female
Location:Texas
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 037K20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest discomfort, Cardiac discomfort

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: vitamin D
Current Illness: recent dental surgery (cavity filling) -- 12/21/2020
Preexisting Conditions: grave''s disease
Allergies: NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Moderna COVID-19 Vaccine Vaccine administration was okay and without issue. Patient reports having sensation of "vice around heart" that spontaneously resolved less than 5 minutes after injection. No anaphylaxis or shortness of breath, but sensation of tightness in chest that subsequently resolved within the 10-15 minutes after injection.


Changed on 5/7/2021

VAERS ID: 909447 Before After
VAERS Form:2
Age:42.0
Sex:Female
Location:Texas
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 037K20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest discomfort, Cardiac discomfort

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: vitamin D
Current Illness: recent dental surgery (cavity filling) -- 12/21/2020
Preexisting Conditions: grave''s disease
Allergies: NKDA NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Moderna COVID-19 Vaccine Vaccine administration was okay and without issue. Patient reports having sensation of "vice around heart" that spontaneously resolved less than 5 minutes after injection. No anaphylaxis or shortness of breath, but sensation of tightness in chest that subsequently resolved within the 10-15 minutes after injection.


Changed on 5/21/2021

VAERS ID: 909447 Before After
VAERS Form:2
Age:42.0
Sex:Female
Location:Texas
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 037K20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest discomfort, Cardiac discomfort

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: vitamin D
Current Illness: recent dental surgery (cavity filling) -- 12/21/2020
Preexisting Conditions: grave''s disease
Allergies: NKDA NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Moderna COVID-19 Vaccine Vaccine administration was okay and without issue. Patient reports having sensation of "vice around heart" that spontaneously resolved less than 5 minutes after injection. No anaphylaxis or shortness of breath, but sensation of tightness in chest that subsequently resolved within the 10-15 minutes after injection.

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