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This is VAERS ID 910021

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 910021
VAERS Form:1
Age:39.0
Sex:Female
Location:Unknown
Vaccinated:2020-12-22
Onset:2020-12-23
Submitted:2020-12-23
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Treatment dugs:


Changed on 5/7/2021

VAERS ID: 910021 Before After
VAERS Form:1
Age:39.0
Sex:Female
Location:Unknown
Vaccinated:2020-12-22
Onset:2020-12-23
Submitted:2020-12-23
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Treatment dugs:


Changed on 5/21/2021

VAERS ID: 910021 Before After
VAERS Form:1
Age:39.0
Sex:Female
Location:Unknown
Vaccinated:2020-12-22
Onset:2020-12-23
Submitted:2020-12-23
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Treatment dugs:

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=910021&WAYBACKHISTORY=ON


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