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This is VAERS ID 918552

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 918552
VAERS Form:2
Age:39.0
Sex:Female
Location:Illinois
Vaccinated:2020-12-30
Onset:2021-01-01
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 5 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chills, Diarrhoea, Nausea, Pyrexia, Influenza virus test negative, SARS-CoV-2 test negative

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Lupus
Preexisting Conditions: Lupus
Allergies: NKA
Diagnostic Lab Data: Pt was tested for Influenza and COVID and lab work was normal
CDC 'Split Type':

Write-up: Severe diarrhea, cold chills, 101 fever, and nausea


Changed on 5/7/2021

VAERS ID: 918552 Before After
VAERS Form:2
Age:39.0
Sex:Female
Location:Illinois
Vaccinated:2020-12-30
Onset:2021-01-01
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 5 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chills, Diarrhoea, Nausea, Pyrexia, Influenza virus test negative, SARS-CoV-2 test negative

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Lupus
Preexisting Conditions: Lupus
Allergies: NKA NKA
Diagnostic Lab Data: Pt was tested for Influenza and COVID and lab work was normal
CDC 'Split Type':

Write-up: Severe diarrhea, cold chills, 101 fever, and nausea


Changed on 5/14/2021

VAERS ID: 918552 Before After
VAERS Form:2
Age:39.0
Sex:Female
Location:Illinois
Vaccinated:2020-12-30
Onset:2021-01-01
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 5 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chills, Diarrhoea, Nausea, Pyrexia, Influenza virus test negative, SARS-CoV-2 test negative

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Lupus
Preexisting Conditions: Lupus
Allergies: NKA NKA
Diagnostic Lab Data: Pt was tested for Influenza and COVID and lab work was normal
CDC 'Split Type':

Write-up: Severe diarrhea, cold chills, 101 fever, and nausea

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