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This is VAERS ID 910723

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 910723
VAERS Form:2
Age:61.0
Sex:Female
Location:New Jersey
Vaccinated:2020-12-26
Onset:2020-12-26
Submitted:0000-00-00
Entered:2020-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA / UNK LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest discomfort, Chest X-ray normal, Cough, Neutrophil percentage increased, Throat clearing

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol 90 mcg/ Aerosol 2 puffs 4 times day Famotidine 20mg po daily Prednisone 20mg po 2 times day Diphenhydramine 25 mg po Q 6 hrs prn
Current Illness: UTI 11/28/2020
Preexisting Conditions: Hx Asthma Hx Uterine Sarcoma
Allergies: MRI Dye, NSAIDs
Diagnostic Lab Data: 12/26 CXR: Negative, no pneumonia, edema or pneumothorax Lab work: Neutrophils 83.6
CDC 'Split Type':

Write-up: 10 minutes after the vaccination, she began clearing her throat, within 30 minutes began coughing, which led to chest tightness. Was evaluated in the ER and admitted for observation. Given: Prednisone 40mg po, Benadryl 25mg po Duoneb x 3 and Pepcid 20mg


Changed on 5/7/2021

VAERS ID: 910723 Before After
VAERS Form:2
Age:61.0
Sex:Female
Location:New Jersey
Vaccinated:2020-12-26
Onset:2020-12-26
Submitted:0000-00-00
Entered:2020-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA / UNK LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest discomfort, Chest X-ray normal, Cough, Neutrophil percentage increased, Throat clearing

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol 90 mcg/ Aerosol 2 puffs 4 times day Famotidine 20mg po daily Prednisone 20mg po 2 times day Diphenhydramine 25 mg po Q 6 hrs prn
Current Illness: UTI 11/28/2020
Preexisting Conditions: Hx Asthma Hx Uterine Sarcoma
Allergies: MRI Dye, NSAIDs NSAIDs
Diagnostic Lab Data: 12/26 CXR: Negative, no pneumonia, edema or pneumothorax Lab work: Neutrophils 83.6
CDC 'Split Type':

Write-up: 10 minutes after the vaccination, she began clearing her throat, within 30 minutes began coughing, which led to chest tightness. Was evaluated in the ER and admitted for observation. Given: Prednisone 40mg po, Benadryl 25mg po Duoneb x 3 and Pepcid 20mg


Changed on 5/14/2021

VAERS ID: 910723 Before After
VAERS Form:2
Age:61.0
Sex:Female
Location:New Jersey
Vaccinated:2020-12-26
Onset:2020-12-26
Submitted:0000-00-00
Entered:2020-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA / UNK LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest discomfort, Chest X-ray normal, Cough, Neutrophil percentage increased, Throat clearing

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol 90 mcg/ Aerosol 2 puffs 4 times day Famotidine 20mg po daily Prednisone 20mg po 2 times day Diphenhydramine 25 mg po Q 6 hrs prn
Current Illness: UTI 11/28/2020
Preexisting Conditions: Hx Asthma Hx Uterine Sarcoma
Allergies: MRI Dye, NSAIDs NSAIDs
Diagnostic Lab Data: 12/26 CXR: Negative, no pneumonia, edema or pneumothorax Lab work: Neutrophils 83.6
CDC 'Split Type':

Write-up: 10 minutes after the vaccination, she began clearing her throat, within 30 minutes began coughing, which led to chest tightness. Was evaluated in the ER and admitted for observation. Given: Prednisone 40mg po, Benadryl 25mg po Duoneb x 3 and Pepcid 20mg

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