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This is VAERS ID 910133

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 910133
VAERS Form:2
Age:64.0
Sex:Female
Location:South Dakota
Vaccinated:2020-12-23
Onset:2020-12-24
Submitted:0000-00-00
Entered:2020-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: C-reactive protein increased, Full blood count normal, Speech disorder, Swollen tongue, X-ray normal

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Guaifenesin, Albuterol Inh, levothyroxine, amlodipine, coreg, Claritin.
Current Illness: none
Preexisting Conditions: Hypothyroidism, Hypertension, menopause
Allergies: environmental (sneezy/watery eyes), ibuprofen,
Diagnostic Lab Data: Labs completed at 1352. CBC WNL. CRP 7.4. Soft tissue neck xray at 1527 with no acute findings.
CDC 'Split Type':

Write-up: Noted tongue starting to swell on 12/24 at 1030. Started on left side, then progressed to right side. No SOB, difficulty swallowing or breathing, but staff noted difficulty understanding her speech. Presented to ED at 1300. 50mg Benadryl given IV on 12/24 at 1328 and 125mg solumedrol given IV at 1327. Pt reported improvement in tongue swelling at 1630.


Changed on 5/7/2021

VAERS ID: 910133 Before After
VAERS Form:2
Age:64.0
Sex:Female
Location:South Dakota
Vaccinated:2020-12-23
Onset:2020-12-24
Submitted:0000-00-00
Entered:2020-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: C-reactive protein increased, Full blood count normal, Speech disorder, Swollen tongue, X-ray normal

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Guaifenesin, Albuterol Inh, levothyroxine, amlodipine, coreg, Claritin.
Current Illness: none
Preexisting Conditions: Hypothyroidism, Hypertension, menopause
Allergies: environmental (sneezy/watery eyes), ibuprofen, ibuprofen,
Diagnostic Lab Data: Labs completed at 1352. CBC WNL. CRP 7.4. Soft tissue neck xray at 1527 with no acute findings.
CDC 'Split Type':

Write-up: Noted tongue starting to swell on 12/24 at 1030. Started on left side, then progressed to right side. No SOB, difficulty swallowing or breathing, but staff noted difficulty understanding her speech. Presented to ED at 1300. 50mg Benadryl given IV on 12/24 at 1328 and 125mg solumedrol given IV at 1327. Pt reported improvement in tongue swelling at 1630.


Changed on 5/14/2021

VAERS ID: 910133 Before After
VAERS Form:2
Age:64.0
Sex:Female
Location:South Dakota
Vaccinated:2020-12-23
Onset:2020-12-24
Submitted:0000-00-00
Entered:2020-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: C-reactive protein increased, Full blood count normal, Speech disorder, Swollen tongue, X-ray normal

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Guaifenesin, Albuterol Inh, levothyroxine, amlodipine, coreg, Claritin.
Current Illness: none
Preexisting Conditions: Hypothyroidism, Hypertension, menopause
Allergies: environmental (sneezy/watery eyes), ibuprofen, ibuprofen,
Diagnostic Lab Data: Labs completed at 1352. CBC WNL. CRP 7.4. Soft tissue neck xray at 1527 with no acute findings.
CDC 'Split Type':

Write-up: Noted tongue starting to swell on 12/24 at 1030. Started on left side, then progressed to right side. No SOB, difficulty swallowing or breathing, but staff noted difficulty understanding her speech. Presented to ED at 1300. 50mg Benadryl given IV on 12/24 at 1328 and 125mg solumedrol given IV at 1327. Pt reported improvement in tongue swelling at 1630.

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