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This is VAERS ID 914082

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 914082
VAERS Form:2
Age:18.0
Sex:Male
Location:Arkansas
Vaccinated:2020-12-29
Onset:2020-12-29
Submitted:0000-00-00
Entered:2020-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Apnoea, Chest X-ray, Dizziness, Dyspnoea, Erythema, Headache, Hypoaesthesia, Hypotension, Swelling face, Tremor, Hypoaesthesia oral, Hot flush

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Covid-19 on 12/16/2020
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: Chest x-ray
CDC 'Split Type':

Write-up: Dizzy, light headed, "hot flash", red face, facial swelling, hypotension, apnea, shaking, mouth numbness. EpiPen given and sent to the emergency department at Hospital. Currently have dyspnea, numbness in arms and legs, headache.


Changed on 5/7/2021

VAERS ID: 914082 Before After
VAERS Form:2
Age:18.0
Sex:Male
Location:Arkansas
Vaccinated:2020-12-29
Onset:2020-12-29
Submitted:0000-00-00
Entered:2020-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Apnoea, Chest X-ray, Dizziness, Dyspnoea, Erythema, Headache, Hypoaesthesia, Hypotension, Swelling face, Tremor, Hypoaesthesia oral, Hot flush

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Covid-19 on 12/16/2020
Preexisting Conditions: None
Allergies: NKA NKA
Diagnostic Lab Data: Chest x-ray
CDC 'Split Type':

Write-up: Dizzy, light headed, "hot flash", red face, facial swelling, hypotension, apnea, shaking, mouth numbness. EpiPen given and sent to the emergency department at Hospital. Currently have dyspnea, numbness in arms and legs, headache.


Changed on 5/14/2021

VAERS ID: 914082 Before After
VAERS Form:2
Age:18.0
Sex:Male
Location:Arkansas
Vaccinated:2020-12-29
Onset:2020-12-29
Submitted:0000-00-00
Entered:2020-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Apnoea, Chest X-ray, Dizziness, Dyspnoea, Erythema, Headache, Hypoaesthesia, Hypotension, Swelling face, Tremor, Hypoaesthesia oral, Hot flush

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Covid-19 on 12/16/2020
Preexisting Conditions: None
Allergies: NKA NKA
Diagnostic Lab Data: Chest x-ray
CDC 'Split Type':

Write-up: Dizzy, light headed, "hot flash", red face, facial swelling, hypotension, apnea, shaking, mouth numbness. EpiPen given and sent to the emergency department at Hospital. Currently have dyspnea, numbness in arms and legs, headache.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=914082&WAYBACKHISTORY=ON


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