National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/19/2021 release of VAERS data:

This is VAERS ID 916710

Government Disclaimer on use of this data



Case Details

VAERS ID: 916710 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Missouri  
Vaccinated:2020-12-29
Onset:2021-01-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Appendicitis, Band neutrophil percentage increased, Surgery, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synthroid
Current Illness:
Preexisting Conditions: Hypothyroidism
Allergies: NKDA
Diagnostic Lab Data: WBCs 13k, 4% Bands, CT with acute appendicitis- taken to surgery
CDC Split Type:

Write-up: Acute appendicitis, onset morning of 1/1/2021 (Reporting this because Pfizer covid vaccine had 3-4x higher risk of appendicitis, although data not reported for Moderna covid vaccine)


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=916710


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166