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This is VAERS ID 909512

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 909512
VAERS Form:2
Age:57.0
Sex:Female
Location:Massachusetts
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 025J20A / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Erythema, Headache, Musculoskeletal chest pain, Sensation of foreign body

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)? No
Hospitalized? No
Previous Vaccinations: Flu shot- feels heaviness to chest area, lump on throat, rash on chest, takes Benadryl and feels better
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Tree nuts, tree fruits except citrus, peanuts
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient reported having reaction to flu shot in past so was being monitored closer. Upon her completion of 30 min observation, patient felt lump on throat, slight pain to touch on upper chest, slight headache, some redness to chest area and arms. Patient came prepared and took 25mg of chewable Benadryl at 10:13am, two minutes after symptoms began. 20 minutes later lump on throat was gone and redness to skin had disappeared. Symptoms resolved, patient was monitored for an extra 15min, asymptomatic upon leaving, had husband waiting outside to drive her home. Patient has EpiPen and understands if any sx return, chest pain, trouble breathing, should go to ED.


Changed on 5/7/2021

VAERS ID: 909512 Before After
VAERS Form:2
Age:57.0
Sex:Female
Location:Massachusetts
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 025J20A / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Erythema, Headache, Musculoskeletal chest pain, Sensation of foreign body

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)? No
Hospitalized? No
Previous Vaccinations: Flu shot- feels heaviness to chest area, lump on throat, rash on chest, takes Benadryl and feels better
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Tree nuts, tree fruits except citrus, peanuts peanuts
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient reported having reaction to flu shot in past so was being monitored closer. Upon her completion of 30 min observation, patient felt lump on throat, slight pain to touch on upper chest, slight headache, some redness to chest area and arms. Patient came prepared and took 25mg of chewable Benadryl at 10:13am, two minutes after symptoms began. 20 minutes later lump on throat was gone and redness to skin had disappeared. Symptoms resolved, patient was monitored for an extra 15min, asymptomatic upon leaving, had husband waiting outside to drive her home. Patient has EpiPen and understands if any sx return, chest pain, trouble breathing, should go to ED.


Changed on 5/21/2021

VAERS ID: 909512 Before After
VAERS Form:2
Age:57.0
Sex:Female
Location:Massachusetts
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 025J20A / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Erythema, Headache, Musculoskeletal chest pain, Sensation of foreign body

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)? No
Hospitalized? No
Previous Vaccinations: Flu shot- feels heaviness to chest area, lump on throat, rash on chest, takes Benadryl and feels better
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Tree nuts, tree fruits except citrus, peanuts peanuts
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient reported having reaction to flu shot in past so was being monitored closer. Upon her completion of 30 min observation, patient felt lump on throat, slight pain to touch on upper chest, slight headache, some redness to chest area and arms. Patient came prepared and took 25mg of chewable Benadryl at 10:13am, two minutes after symptoms began. 20 minutes later lump on throat was gone and redness to skin had disappeared. Symptoms resolved, patient was monitored for an extra 15min, asymptomatic upon leaving, had husband waiting outside to drive her home. Patient has EpiPen and understands if any sx return, chest pain, trouble breathing, should go to ED.

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