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This is VAERS ID 909457

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 909457
VAERS Form:2
Age:39.0
Sex:Male
Location:Ohio
Vaccinated:2020-12-24
Onset:2020-12-24
Submitted:0000-00-00
Entered:2020-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K2OA / 1 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Dizziness, Dyspnoea, Electrocardiogram, Fatigue, Feeling hot, Flushing, Headache, Injection site pain, Nausea, Syncope, Blood test

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Roustevstatin, Victoza, Jardiance, Celexa, Hydroxzine, Vit D, multivitamin
Current Illness: N/A
Preexisting Conditions: Morbid Obesity, Type 2 Diabetes, Depression (in remission)
Allergies: Mild allergy to shellfish
Diagnostic Lab Data: 12/26 - EKG, blood work
CDC 'Split Type':

Write-up: Day 1/2 - Headache, Pain at injection site/slight arm sweeping, tiredness Day 2 - nausea, tiredness, dizziness, shortness of breath, feeling hot/flushed, fainted (led to a 911 call / ED visit)


Changed on 5/7/2021

VAERS ID: 909457 Before After
VAERS Form:2
Age:39.0
Sex:Male
Location:Ohio
Vaccinated:2020-12-24
Onset:2020-12-24
Submitted:0000-00-00
Entered:2020-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K2OA / 1 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Dizziness, Dyspnoea, Electrocardiogram, Fatigue, Feeling hot, Flushing, Headache, Injection site pain, Nausea, Syncope, Blood test

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Roustevstatin, Victoza, Jardiance, Celexa, Hydroxzine, Vit D, multivitamin
Current Illness: N/A
Preexisting Conditions: Morbid Obesity, Type 2 Diabetes, Depression (in remission)
Allergies: Mild allergy to shellfish shellfish
Diagnostic Lab Data: 12/26 - EKG, blood work
CDC 'Split Type':

Write-up: Day 1/2 - Headache, Pain at injection site/slight arm sweeping, tiredness Day 2 - nausea, tiredness, dizziness, shortness of breath, feeling hot/flushed, fainted (led to a 911 call / ED visit)


Changed on 5/21/2021

VAERS ID: 909457 Before After
VAERS Form:2
Age:39.0
Sex:Male
Location:Ohio
Vaccinated:2020-12-24
Onset:2020-12-24
Submitted:0000-00-00
Entered:2020-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K2OA / 1 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Dizziness, Dyspnoea, Electrocardiogram, Fatigue, Feeling hot, Flushing, Headache, Injection site pain, Nausea, Syncope, Blood test

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Roustevstatin, Victoza, Jardiance, Celexa, Hydroxzine, Vit D, multivitamin
Current Illness: N/A
Preexisting Conditions: Morbid Obesity, Type 2 Diabetes, Depression (in remission)
Allergies: Mild allergy to shellfish shellfish
Diagnostic Lab Data: 12/26 - EKG, blood work
CDC 'Split Type':

Write-up: Day 1/2 - Headache, Pain at injection site/slight arm sweeping, tiredness Day 2 - nausea, tiredness, dizziness, shortness of breath, feeling hot/flushed, fainted (led to a 911 call / ED visit)

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