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This is VAERS ID 912511

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 912511
VAERS Form:2
Age:39.0
Sex:Female
Location:Washington
Vaccinated:2020-12-28
Onset:2020-12-28
Submitted:0000-00-00
Entered:2020-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Full blood count, Hypoaesthesia, Lip swelling, Paraesthesia, Swelling of eyelid, Visual impairment, Hypoaesthesia oral, Paraesthesia oral, Metabolic function test

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zinc 50 mg daily Vitamin D3 5000 IU daily Trazodone 50 mg daily Melatonin 5 mg daily
Current Illness: None
Preexisting Conditions: None
Allergies: Erythromycin
Diagnostic Lab Data: Laboratory results pending. Will check CBC, CMP.
CDC 'Split Type':

Write-up: Received vaccine at 1:30 pm yesterday, noted onset of symptoms at 8:45 pm. Numbness and tingling to mouth and bilateral upper and lower extremities, mild vision change, feeling of some swelling to bilateral eyelids. Also swelling to lips. She also did take zinc gluconate 50 mg last night and this morning. Has never taken zinc 50 mg, but has taken zinc as component of multivitamin/pre-natal vitamins. Patient was prescribed Pepcid 20 mg BID, Medrol 4 mg dose pack 21 pill taper until complete. Also given Benadryl 25 mg - 50 mg every 4 - 6 hours for allergy symptoms. And provided with an Epi-Pen for home.


Changed on 5/7/2021

VAERS ID: 912511 Before After
VAERS Form:2
Age:39.0
Sex:Female
Location:Washington
Vaccinated:2020-12-28
Onset:2020-12-28
Submitted:0000-00-00
Entered:2020-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Full blood count, Hypoaesthesia, Lip swelling, Paraesthesia, Swelling of eyelid, Visual impairment, Hypoaesthesia oral, Paraesthesia oral, Metabolic function test

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zinc 50 mg daily Vitamin D3 5000 IU daily Trazodone 50 mg daily Melatonin 5 mg daily
Current Illness: None
Preexisting Conditions: None
Allergies: Erythromycin Erythromycin
Diagnostic Lab Data: Laboratory results pending. Will check CBC, CMP.
CDC 'Split Type':

Write-up: Received vaccine at 1:30 pm yesterday, noted onset of symptoms at 8:45 pm. Numbness and tingling to mouth and bilateral upper and lower extremities, mild vision change, feeling of some swelling to bilateral eyelids. Also swelling to lips. She also did take zinc gluconate 50 mg last night and this morning. Has never taken zinc 50 mg, but has taken zinc as component of multivitamin/pre-natal vitamins. Patient was prescribed Pepcid 20 mg BID, Medrol 4 mg dose pack 21 pill taper until complete. Also given Benadryl 25 mg - 50 mg every 4 - 6 hours for allergy symptoms. And provided with an Epi-Pen for home.


Changed on 5/14/2021

VAERS ID: 912511 Before After
VAERS Form:2
Age:39.0
Sex:Female
Location:Washington
Vaccinated:2020-12-28
Onset:2020-12-28
Submitted:0000-00-00
Entered:2020-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Full blood count, Hypoaesthesia, Lip swelling, Paraesthesia, Swelling of eyelid, Visual impairment, Hypoaesthesia oral, Paraesthesia oral, Metabolic function test

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zinc 50 mg daily Vitamin D3 5000 IU daily Trazodone 50 mg daily Melatonin 5 mg daily
Current Illness: None
Preexisting Conditions: None
Allergies: Erythromycin Erythromycin
Diagnostic Lab Data: Laboratory results pending. Will check CBC, CMP.
CDC 'Split Type':

Write-up: Received vaccine at 1:30 pm yesterday, noted onset of symptoms at 8:45 pm. Numbness and tingling to mouth and bilateral upper and lower extremities, mild vision change, feeling of some swelling to bilateral eyelids. Also swelling to lips. She also did take zinc gluconate 50 mg last night and this morning. Has never taken zinc 50 mg, but has taken zinc as component of multivitamin/pre-natal vitamins. Patient was prescribed Pepcid 20 mg BID, Medrol 4 mg dose pack 21 pill taper until complete. Also given Benadryl 25 mg - 50 mg every 4 - 6 hours for allergy symptoms. And provided with an Epi-Pen for home.

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