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This is VAERS ID 917865

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 917865
VAERS Form:2
Age:18.0
Sex:Female
Location:New Jersey
Vaccinated:2020-12-29
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Chills, Dizziness, Fatigue, Headache, Pain in extremity

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: viral cold 3 weeks before (throat pain, chills, fever, fatigue) - NOT COVID (tested negative), or Flu (symptoms only lasted 48 hours and lower fevers)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: intense chills and arm pain starting ~5 hours after shot (child faded within 24 hours) arm soreness lasted ~3 days general intense fatigue and light-headedness/ headache; decreased and went away after 48 hours


Changed on 5/7/2021

VAERS ID: 917865 Before After
VAERS Form:2
Age:18.0
Sex:Female
Location:New Jersey
Vaccinated:2020-12-29
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Chills, Dizziness, Fatigue, Headache, Pain in extremity

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: viral cold 3 weeks before (throat pain, chills, fever, fatigue) - NOT COVID (tested negative), or Flu (symptoms only lasted 48 hours and lower fevers)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: intense chills and arm pain starting ~5 hours after shot (child faded within 24 hours) arm soreness lasted ~3 days general intense fatigue and light-headedness/ headache; decreased and went away after 48 hours


Changed on 5/21/2021

VAERS ID: 917865 Before After
VAERS Form:2
Age:18.0
Sex:Female
Location:New Jersey
Vaccinated:2020-12-29
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Chills, Dizziness, Fatigue, Headache, Pain in extremity

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: viral cold 3 weeks before (throat pain, chills, fever, fatigue) - NOT COVID (tested negative), or Flu (symptoms only lasted 48 hours and lower fevers)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: intense chills and arm pain starting ~5 hours after shot (child faded within 24 hours) arm soreness lasted ~3 days general intense fatigue and light-headedness/ headache; decreased and went away after 48 hours

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=917865&WAYBACKHISTORY=ON


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