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This is VAERS ID 910065

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 910065
VAERS Form:2
Age:45.0
Sex:Female
Location:Kentucky
Vaccinated:2020-12-23
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Flushing, Throat tightness, Hypoaesthesia oral

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: Received IV steroids in ER
CDC 'Split Type':

Write-up: Moderna COVID 19 Vaccination administered IM L deltoid. Client stayed 30 minutes for observation. Left and approximately 15 minutes later experienced numbness in tongue and neck area-felt like throat was constricting. Drove self back to clinic with epi and benadryl administered IM and oxygen placed at 8l. Blood pressure 170/98, HR 108. States felt better but after approximately 15 minutes became flushed and felt like it was returning. Left with practicing MD & NP to go to ER.


Changed on 5/7/2021

VAERS ID: 910065 Before After
VAERS Form:2
Age:45.0
Sex:Female
Location:Kentucky
Vaccinated:2020-12-23
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Flushing, Throat tightness, Hypoaesthesia oral

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKDA NKDA
Diagnostic Lab Data: Received IV steroids in ER
CDC 'Split Type':

Write-up: Moderna COVID 19 Vaccination administered IM L deltoid. Client stayed 30 minutes for observation. Left and approximately 15 minutes later experienced numbness in tongue and neck area-felt like throat was constricting. Drove self back to clinic with epi and benadryl administered IM and oxygen placed at 8l. Blood pressure 170/98, HR 108. States felt better but after approximately 15 minutes became flushed and felt like it was returning. Left with practicing MD & NP to go to ER.


Changed on 5/21/2021

VAERS ID: 910065 Before After
VAERS Form:2
Age:45.0
Sex:Female
Location:Kentucky
Vaccinated:2020-12-23
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Flushing, Throat tightness, Hypoaesthesia oral

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKDA NKDA
Diagnostic Lab Data: Received IV steroids in ER
CDC 'Split Type':

Write-up: Moderna COVID 19 Vaccination administered IM L deltoid. Client stayed 30 minutes for observation. Left and approximately 15 minutes later experienced numbness in tongue and neck area-felt like throat was constricting. Drove self back to clinic with epi and benadryl administered IM and oxygen placed at 8l. Blood pressure 170/98, HR 108. States felt better but after approximately 15 minutes became flushed and felt like it was returning. Left with practicing MD & NP to go to ER.

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