National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 919252

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 919252
VAERS Form:2
Age:27.0
Sex:Female
Location:Maine
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest discomfort, Headache, Palpitations, Pyrexia, Rash, Skin discomfort

Life Threatening? Yes
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)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: NKA
Diagnostic Lab Data: EE was seen in the emergency room and admitted to Hospital. She remains inpatient today 1/4/21.
CDC 'Split Type':

Write-up: Employee received COVID 19 vaccination at 9:45am on 12/30/20. ~15 min. later she developed a rash down her left arm, then down her Rt. arm. about 4 hours later she decided to go to the emergency room for Hearty Palpitations, Fever, Chest discomfort and feeling of generalized sunburn. Later developed severe headache..


Changed on 5/7/2021

VAERS ID: 919252 Before After
VAERS Form:2
Age:27.0
Sex:Female
Location:Maine
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest discomfort, Headache, Palpitations, Pyrexia, Rash, Skin discomfort

Life Threatening? Yes
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)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: NKA NKA
Diagnostic Lab Data: EE was seen in the emergency room and admitted to Hospital. She remains inpatient today 1/4/21.
CDC 'Split Type':

Write-up: Employee received COVID 19 vaccination at 9:45am on 12/30/20. ~15 min. later she developed a rash down her left arm, then down her Rt. arm. about 4 hours later she decided to go to the emergency room for Hearty Palpitations, Fever, Chest discomfort and feeling of generalized sunburn. Later developed severe headache..


Changed on 5/14/2021

VAERS ID: 919252 Before After
VAERS Form:2
Age:27.0
Sex:Female
Location:Maine
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest discomfort, Headache, Palpitations, Pyrexia, Rash, Skin discomfort

Life Threatening? Yes
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)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: NKA NKA
Diagnostic Lab Data: EE was seen in the emergency room and admitted to Hospital. She remains inpatient today 1/4/21.
CDC 'Split Type':

Write-up: Employee received COVID 19 vaccination at 9:45am on 12/30/20. ~15 min. later she developed a rash down her left arm, then down her Rt. arm. about 4 hours later she decided to go to the emergency room for Hearty Palpitations, Fever, Chest discomfort and feeling of generalized sunburn. Later developed severe headache..

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=919252&WAYBACKHISTORY=ON


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