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This is VAERS ID 909480

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 909480
VAERS Form:2
Age:34.0
Sex:Female
Location:Unknown
Vaccinated:2020-12-26
Onset:2020-12-26
Submitted:0000-00-00
Entered:2020-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Chest discomfort, Dizziness, Electrocardiogram, Heart rate increased, Hypoaesthesia, Palpitations, Paraesthesia, Tachycardia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Bactrim
Diagnostic Lab Data: EKG 12/26/20
CDC 'Split Type':

Write-up: Symptoms started after 2-3 mins of vaccine. Started having numbness, tingling on face, arms, legs, tachycardia up to 144 bpm, dizziness, palpitations, chest tightness. Lasted up to 1 hour. Observed in clinic and went home after 2.5 hrs. At home continued to have on and off palpitations for 2-3 hrs with heart rate increasing to 110 bpm.


Changed on 5/7/2021

VAERS ID: 909480 Before After
VAERS Form:2
Age:34.0
Sex:Female
Location:Unknown
Vaccinated:2020-12-26
Onset:2020-12-26
Submitted:0000-00-00
Entered:2020-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Chest discomfort, Dizziness, Electrocardiogram, Heart rate increased, Hypoaesthesia, Palpitations, Paraesthesia, Tachycardia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Bactrim Bactrim
Diagnostic Lab Data: EKG 12/26/20
CDC 'Split Type':

Write-up: Symptoms started after 2-3 mins of vaccine. Started having numbness, tingling on face, arms, legs, tachycardia up to 144 bpm, dizziness, palpitations, chest tightness. Lasted up to 1 hour. Observed in clinic and went home after 2.5 hrs. At home continued to have on and off palpitations for 2-3 hrs with heart rate increasing to 110 bpm.


Changed on 5/21/2021

VAERS ID: 909480 Before After
VAERS Form:2
Age:34.0
Sex:Female
Location:Unknown
Vaccinated:2020-12-26
Onset:2020-12-26
Submitted:0000-00-00
Entered:2020-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Chest discomfort, Dizziness, Electrocardiogram, Heart rate increased, Hypoaesthesia, Palpitations, Paraesthesia, Tachycardia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Bactrim Bactrim
Diagnostic Lab Data: EKG 12/26/20
CDC 'Split Type':

Write-up: Symptoms started after 2-3 mins of vaccine. Started having numbness, tingling on face, arms, legs, tachycardia up to 144 bpm, dizziness, palpitations, chest tightness. Lasted up to 1 hour. Observed in clinic and went home after 2.5 hrs. At home continued to have on and off palpitations for 2-3 hrs with heart rate increasing to 110 bpm.

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