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This is VAERS ID 909467

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 909467
VAERS Form:2
Age:42.0
Sex:Female
Location:Tennessee
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 LA / IM

Administered by: School      Purchased by: ??
Symptoms: Flushing, Headache, Eye pruritus, Pharyngeal swelling

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: Flu vaccine
Other Medications: Claritin Vistaril Prilosec Gabapentin Norco Zanaflex
Current Illness: none
Preexisting Conditions: anxiety chronic pain
Allergies: Lyrica Flu vaccine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: throat swelling, itchy eyes, flushed skin and a headache


Changed on 5/7/2021

VAERS ID: 909467 Before After
VAERS Form:2
Age:42.0
Sex:Female
Location:Tennessee
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 LA / IM

Administered by: School      Purchased by: ??
Symptoms: Flushing, Headache, Eye pruritus, Pharyngeal swelling

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: Flu vaccine
Other Medications: Claritin Vistaril Prilosec Gabapentin Norco Zanaflex
Current Illness: none
Preexisting Conditions: anxiety chronic pain
Allergies: Lyrica Flu vaccine vaccine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: throat swelling, itchy eyes, flushed skin and a headache


Changed on 5/21/2021

VAERS ID: 909467 Before After
VAERS Form:2
Age:42.0
Sex:Female
Location:Tennessee
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 LA / IM

Administered by: School      Purchased by: ??
Symptoms: Flushing, Headache, Eye pruritus, Pharyngeal swelling

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: Flu vaccine
Other Medications: Claritin Vistaril Prilosec Gabapentin Norco Zanaflex
Current Illness: none
Preexisting Conditions: anxiety chronic pain
Allergies: Lyrica Flu vaccine vaccine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: throat swelling, itchy eyes, flushed skin and a headache

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