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This is VAERS ID 909522

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 909522
VAERS Form:2
Age:36.0
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 011J20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Condition aggravated, Dizziness, Injection site pain, Migraine, Pain, Pruritus, Hypoaesthesia oral, Paraesthesia oral, Injected limb mobility decreased, Limb discomfort, Oropharyngeal discomfort, Tongue pruritus, Loss of personal independence in daily activities

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: 10/2006 (age 22) & 04/2016 (age 32) vaccine dtap - severe side effects post vaccine x 1 week: sore throat, cold, severe headache
Other Medications: Centrum women?s multivitamin, vitamin D3 1,000 units, super B complex vitamin, excederin migraine as needed
Current Illness: None
Preexisting Conditions: Migraines
Allergies: Shellfish (allergic reaction), dtap vaccine - severe side effects 2006 & 2016
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Saturday 12/26/2020 received Moderna vaccine dose #1 of 2 at 12:00pm. 15 minute observation required (no symptoms) was able to leave. At 12:30 pm - 30 minutes post vaccine: experienced lip & tongue tingling & numbness, throat felt weird. Jaw line became itchy. Self-resolved 15-20 minutes after. At 2:00pm experienced severe migraine & lightheadedness - unable to perform daily routine due to pain & feeling of passing out. At 3:15 pm tongue became itchy & throat feeling weird again. Self-resolved 15 minutes later. Today 12/27/2020 only symptom is severe pain in left upper arm (where injection was) feels like solid mass & difficulty raising arm due to pain & tight feeling (this is very different than just having sore arm post flu vaccine). Pain in arm constant throbbing heavy pain.


Changed on 5/7/2021

VAERS ID: 909522 Before After
VAERS Form:2
Age:36.0
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 011J20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Condition aggravated, Dizziness, Injection site pain, Migraine, Pain, Pruritus, Hypoaesthesia oral, Paraesthesia oral, Injected limb mobility decreased, Limb discomfort, Oropharyngeal discomfort, Tongue pruritus, Loss of personal independence in daily activities

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: 10/2006 (age 22) & 04/2016 (age 32) vaccine dtap - severe side effects post vaccine x 1 week: sore throat, cold, severe headache
Other Medications: Centrum women?s multivitamin, vitamin D3 1,000 units, super B complex vitamin, excederin migraine as needed
Current Illness: None
Preexisting Conditions: Migraines
Allergies: Shellfish (allergic reaction), dtap vaccine - severe side effects 2006 & 2016 2016
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Saturday 12/26/2020 received Moderna vaccine dose #1 of 2 at 12:00pm. 15 minute observation required (no symptoms) was able to leave. At 12:30 pm - 30 minutes post vaccine: experienced lip & tongue tingling & numbness, throat felt weird. Jaw line became itchy. Self-resolved 15-20 minutes after. At 2:00pm experienced severe migraine & lightheadedness - unable to perform daily routine due to pain & feeling of passing out. At 3:15 pm tongue became itchy & throat feeling weird again. Self-resolved 15 minutes later. Today 12/27/2020 only symptom is severe pain in left upper arm (where injection was) feels like solid mass & difficulty raising arm due to pain & tight feeling (this is very different than just having sore arm post flu vaccine). Pain in arm constant throbbing heavy pain.


Changed on 5/21/2021

VAERS ID: 909522 Before After
VAERS Form:2
Age:36.0
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 011J20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Condition aggravated, Dizziness, Injection site pain, Migraine, Pain, Pruritus, Hypoaesthesia oral, Paraesthesia oral, Injected limb mobility decreased, Limb discomfort, Oropharyngeal discomfort, Tongue pruritus, Loss of personal independence in daily activities

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: 10/2006 (age 22) & 04/2016 (age 32) vaccine dtap - severe side effects post vaccine x 1 week: sore throat, cold, severe headache
Other Medications: Centrum women?s multivitamin, vitamin D3 1,000 units, super B complex vitamin, excederin migraine as needed
Current Illness: None
Preexisting Conditions: Migraines
Allergies: Shellfish (allergic reaction), dtap vaccine - severe side effects 2006 & 2016 2016
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Saturday 12/26/2020 received Moderna vaccine dose #1 of 2 at 12:00pm. 15 minute observation required (no symptoms) was able to leave. At 12:30 pm - 30 minutes post vaccine: experienced lip & tongue tingling & numbness, throat felt weird. Jaw line became itchy. Self-resolved 15-20 minutes after. At 2:00pm experienced severe migraine & lightheadedness - unable to perform daily routine due to pain & feeling of passing out. At 3:15 pm tongue became itchy & throat feeling weird again. Self-resolved 15 minutes later. Today 12/27/2020 only symptom is severe pain in left upper arm (where injection was) feels like solid mass & difficulty raising arm due to pain & tight feeling (this is very different than just having sore arm post flu vaccine). Pain in arm constant throbbing heavy pain.

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