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This is VAERS ID 909482

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 909482
VAERS Form:2
Age:27.0
Sex:Female
Location:California
Vaccinated:2020-12-22
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J02A / UNK UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Anxiety, Chills, Cough, Dizziness, Fatigue, Headache, Nasal congestion, Pain

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: tylenol, ibuprofen, mucinex, nyquil
Current Illness: 12/2 tested positive for COVID 19
Preexisting Conditions: none
Allergies: nkda
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: 12/23 report feeling lightheaded, anxious, body aches, fatigue, headaches, chills without fever, dry cough and nasal congestion


Changed on 5/7/2021

VAERS ID: 909482 Before After
VAERS Form:2
Age:27.0
Sex:Female
Location:California
Vaccinated:2020-12-22
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J02A / UNK UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Anxiety, Chills, Cough, Dizziness, Fatigue, Headache, Nasal congestion, Pain

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: tylenol, ibuprofen, mucinex, nyquil
Current Illness: 12/2 tested positive for COVID 19
Preexisting Conditions: none
Allergies: nkda nkda
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: 12/23 report feeling lightheaded, anxious, body aches, fatigue, headaches, chills without fever, dry cough and nasal congestion


Changed on 5/21/2021

VAERS ID: 909482 Before After
VAERS Form:2
Age:27.0
Sex:Female
Location:California
Vaccinated:2020-12-22
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J02A / UNK UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Anxiety, Chills, Cough, Dizziness, Fatigue, Headache, Nasal congestion, Pain

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: tylenol, ibuprofen, mucinex, nyquil
Current Illness: 12/2 tested positive for COVID 19
Preexisting Conditions: none
Allergies: nkda nkda
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: 12/23 report feeling lightheaded, anxious, body aches, fatigue, headaches, chills without fever, dry cough and nasal congestion

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=909482&WAYBACKHISTORY=ON


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