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This is VAERS ID 919604

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 919604
VAERS Form:2
Age:30.0
Sex:Female
Location:Mississippi
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 037K20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Alanine aminotransferase normal, Anion gap decreased, Aspartate aminotransferase normal, Basophil count normal, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium normal, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood magnesium normal, Blood potassium decreased, Blood sodium normal, Blood thyroid stimulating hormone normal, Blood urea normal, Carbon dioxide decreased, Chest discomfort, Chest X-ray normal, Cough, Dizziness, Eosinophil count decreased, Glomerular filtration rate, Haematocrit normal, Haemoglobin normal, Hypoaesthesia, Injection site pain, Lymphocyte count decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Monocyte count normal, Nausea, Neutrophil count increased, Pain in extremity, Platelet count normal, Protein total normal, Red blood cell count normal, Throat tightness, White blood cell count normal, Basophil percentage decreased, Eosinophil percentage decreased, Neutrophil percentage increased, Monocyte percentage decreased, Lymphocyte percentage decreased, Red cell distribution width increased, Mean platelet volume normal, Blood urea nitrogen/creatinine ratio, Troponin normal, Injection site hypoaesthesia, Red blood cell nucleated morphology, Immature granulocyte count increased, Immature granulocyte percentage increased

Life Threatening? Yes
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)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amitriptyline 25 mg PO QHS Bupropion XL 150 mg PO Daily Cyanocobalamin 1000 mcg PO once weekly Ferrous sulfate DR 324 mg PO Daily Levothyroxine 100 mcg PO Daily Methocarbamol 500 mg PO TID prn muscle spasms Scopolamine 1.5 mg patch transder
Current Illness:
Preexisting Conditions: Anemia Asthma Depression Hypothyroidism secondary to thyroid cancer s/p thyroidectomy Hypertension Migraines Vertigo
Allergies: No known allergies
Diagnostic Lab Data: Chest X-ray (12/30/20 @ 1737): The cardiac and mediastinal silhouette are unremarkable. The lungs are free of infiltrates and masses. I see no acute chest disease on today''s film. CBC w/diff (12/30/2020 @ 1658) WBC: 9.0 RBC: 4.38 Hemoglobin: 13.3 Hematocrit: 39.8 MCV: 90.9 MCH: 30.4 MCHC: 33.4 RDW SD: 40.4 Platelet: 264 MPV: 9 NRBC Percent: 0.0 NRBC Absolute: 0.000 Absolute Neutrophil: 8.4 (H) Lymphocyte Absolute: 0.4 (L) Monocytes Absolute, Automated: 0.11 Absolute Eosinophil: 0.00 (L) Basophil Absolute: 0.03 Absolute Immature Granulocytes: 0.03 (H) Neutrophil percent: 93.6 (H) Lymphocyte percent: 4.6 (L) Monocyte percent: 1.2 Eosinophil percent: 0.0 Basophil percent: 0.3 Immature Granulocytes percent: 0.30 (H) CMP (12/30/2020 @ 1658) Sodium: 136 Potassium: 3.3 (L) Chloride: 106 CO2: 21 Anion gap: 9 Glucose: 137 (H) BUN: 15 Creatinine: 1.01 BUN/Creatinine Ratio: 14.9 Calcium: 9.2 Protein total: 7.9 Albumin: 4.6 AST: 12 ALT: 17 ALP: 50 eGFR non-African American: $g60.0 eGFR African American: $g60.0 Bilirubin total: 0.4 Magnesium: 2.0 TSH: 2.52 Cardiovascular (12/30/2020 @ 1658) Troponin: <0.015
CDC 'Split Type':

Write-up: Presented to the ED after developing chest tightness, cough, lightheadedness, and throat closing sensation. She received the Moderna COVID-19 vaccine on the morning of presentation. Within 15 minutes of receiving the vaccine she developed pain and numbness, starting at the injection site traveling down the ulnar aspect of her arm, and nausea. Over the next several hours she continued to develop worsening nausea, chest tightness, cough, lightheadedness, and the sensation that her throat closing. She took PO Benadryl 25mg; however, her symptoms were not alleviated. She was subsequently evaluated in the ED. ? Received PO Benadryl 25mg, IV Benadryl 25mg, Epinephrine 0.3mg x 2, IV Famotidine 20mg, IV Solumedrol 125mg & 60mg, DuoNebs x 3, Racepinephrine x 1.


Changed on 5/7/2021

VAERS ID: 919604 Before After
VAERS Form:2
Age:30.0
Sex:Female
Location:Mississippi
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 037K20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Alanine aminotransferase normal, Anion gap decreased, Aspartate aminotransferase normal, Basophil count normal, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium normal, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood magnesium normal, Blood potassium decreased, Blood sodium normal, Blood thyroid stimulating hormone normal, Blood urea normal, Carbon dioxide decreased, Chest discomfort, Chest X-ray normal, Cough, Dizziness, Eosinophil count decreased, Glomerular filtration rate, Haematocrit normal, Haemoglobin normal, Hypoaesthesia, Injection site pain, Lymphocyte count decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Monocyte count normal, Nausea, Neutrophil count increased, Pain in extremity, Platelet count normal, Protein total normal, Red blood cell count normal, Throat tightness, White blood cell count normal, Basophil percentage decreased, Eosinophil percentage decreased, Neutrophil percentage increased, Monocyte percentage decreased, Lymphocyte percentage decreased, Red cell distribution width increased, Mean platelet volume normal, Blood urea nitrogen/creatinine ratio, Troponin normal, Injection site hypoaesthesia, Red blood cell nucleated morphology, Immature granulocyte count increased, Immature granulocyte percentage increased

Life Threatening? Yes
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)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amitriptyline 25 mg PO QHS Bupropion XL 150 mg PO Daily Cyanocobalamin 1000 mcg PO once weekly Ferrous sulfate DR 324 mg PO Daily Levothyroxine 100 mcg PO Daily Methocarbamol 500 mg PO TID prn muscle spasms Scopolamine 1.5 mg patch transder
Current Illness:
Preexisting Conditions: Anemia Asthma Depression Hypothyroidism secondary to thyroid cancer s/p thyroidectomy Hypertension Migraines Vertigo
Allergies: No known allergies allergies
Diagnostic Lab Data: Chest X-ray (12/30/20 @ 1737): The cardiac and mediastinal silhouette are unremarkable. The lungs are free of infiltrates and masses. I see no acute chest disease on today''s film. CBC w/diff (12/30/2020 @ 1658) WBC: 9.0 RBC: 4.38 Hemoglobin: 13.3 Hematocrit: 39.8 MCV: 90.9 MCH: 30.4 MCHC: 33.4 RDW SD: 40.4 Platelet: 264 MPV: 9 NRBC Percent: 0.0 NRBC Absolute: 0.000 Absolute Neutrophil: 8.4 (H) Lymphocyte Absolute: 0.4 (L) Monocytes Absolute, Automated: 0.11 Absolute Eosinophil: 0.00 (L) Basophil Absolute: 0.03 Absolute Immature Granulocytes: 0.03 (H) Neutrophil percent: 93.6 (H) Lymphocyte percent: 4.6 (L) Monocyte percent: 1.2 Eosinophil percent: 0.0 Basophil percent: 0.3 Immature Granulocytes percent: 0.30 (H) CMP (12/30/2020 @ 1658) Sodium: 136 Potassium: 3.3 (L) Chloride: 106 CO2: 21 Anion gap: 9 Glucose: 137 (H) BUN: 15 Creatinine: 1.01 BUN/Creatinine Ratio: 14.9 Calcium: 9.2 Protein total: 7.9 Albumin: 4.6 AST: 12 ALT: 17 ALP: 50 eGFR non-African American: $g60.0 eGFR African American: $g60.0 Bilirubin total: 0.4 Magnesium: 2.0 TSH: 2.52 Cardiovascular (12/30/2020 @ 1658) Troponin: <0.015
CDC 'Split Type':

Write-up: Presented to the ED after developing chest tightness, cough, lightheadedness, and throat closing sensation. She received the Moderna COVID-19 vaccine on the morning of presentation. Within 15 minutes of receiving the vaccine she developed pain and numbness, starting at the injection site traveling down the ulnar aspect of her arm, and nausea. Over the next several hours she continued to develop worsening nausea, chest tightness, cough, lightheadedness, and the sensation that her throat closing. She took PO Benadryl 25mg; however, her symptoms were not alleviated. She was subsequently evaluated in the ED. ?   Received PO Benadryl 25mg, IV Benadryl 25mg, Epinephrine 0.3mg x 2, IV Famotidine 20mg, IV Solumedrol 125mg & 60mg, DuoNebs x 3, Racepinephrine x 1.


Changed on 5/14/2021

VAERS ID: 919604 Before After
VAERS Form:2
Age:30.0
Sex:Female
Location:Mississippi
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 037K20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Alanine aminotransferase normal, Anion gap decreased, Aspartate aminotransferase normal, Basophil count normal, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium normal, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood magnesium normal, Blood potassium decreased, Blood sodium normal, Blood thyroid stimulating hormone normal, Blood urea normal, Carbon dioxide decreased, Chest discomfort, Chest X-ray normal, Cough, Dizziness, Eosinophil count decreased, Glomerular filtration rate, Haematocrit normal, Haemoglobin normal, Hypoaesthesia, Injection site pain, Lymphocyte count decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Monocyte count normal, Nausea, Neutrophil count increased, Pain in extremity, Platelet count normal, Protein total normal, Red blood cell count normal, Throat tightness, White blood cell count normal, Basophil percentage decreased, Eosinophil percentage decreased, Neutrophil percentage increased, Monocyte percentage decreased, Lymphocyte percentage decreased, Red cell distribution width increased, Mean platelet volume normal, Blood urea nitrogen/creatinine ratio, Troponin normal, Injection site hypoaesthesia, Red blood cell nucleated morphology, Immature granulocyte count increased, Immature granulocyte percentage increased

Life Threatening? Yes
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)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amitriptyline 25 mg PO QHS Bupropion XL 150 mg PO Daily Cyanocobalamin 1000 mcg PO once weekly Ferrous sulfate DR 324 mg PO Daily Levothyroxine 100 mcg PO Daily Methocarbamol 500 mg PO TID prn muscle spasms Scopolamine 1.5 mg patch transder
Current Illness:
Preexisting Conditions: Anemia Asthma Depression Hypothyroidism secondary to thyroid cancer s/p thyroidectomy Hypertension Migraines Vertigo
Allergies: No known allergies allergies
Diagnostic Lab Data: Chest X-ray (12/30/20 @ 1737): The cardiac and mediastinal silhouette are unremarkable. The lungs are free of infiltrates and masses. I see no acute chest disease on today''s film. CBC w/diff (12/30/2020 @ 1658) WBC: 9.0 RBC: 4.38 Hemoglobin: 13.3 Hematocrit: 39.8 MCV: 90.9 MCH: 30.4 MCHC: 33.4 RDW SD: 40.4 Platelet: 264 MPV: 9 NRBC Percent: 0.0 NRBC Absolute: 0.000 Absolute Neutrophil: 8.4 (H) Lymphocyte Absolute: 0.4 (L) Monocytes Absolute, Automated: 0.11 Absolute Eosinophil: 0.00 (L) Basophil Absolute: 0.03 Absolute Immature Granulocytes: 0.03 (H) Neutrophil percent: 93.6 (H) Lymphocyte percent: 4.6 (L) Monocyte percent: 1.2 Eosinophil percent: 0.0 Basophil percent: 0.3 Immature Granulocytes percent: 0.30 (H) CMP (12/30/2020 @ 1658) Sodium: 136 Potassium: 3.3 (L) Chloride: 106 CO2: 21 Anion gap: 9 Glucose: 137 (H) BUN: 15 Creatinine: 1.01 BUN/Creatinine Ratio: 14.9 Calcium: 9.2 Protein total: 7.9 Albumin: 4.6 AST: 12 ALT: 17 ALP: 50 eGFR non-African American: $g60.0 eGFR African American: $g60.0 Bilirubin total: 0.4 Magnesium: 2.0 TSH: 2.52 Cardiovascular (12/30/2020 @ 1658) Troponin: <0.015
CDC 'Split Type':

Write-up: Presented to the ED after developing chest tightness, cough, lightheadedness, and throat closing sensation. She received the Moderna COVID-19 vaccine on the morning of presentation. Within 15 minutes of receiving the vaccine she developed pain and numbness, starting at the injection site traveling down the ulnar aspect of her arm, and nausea. Over the next several hours she continued to develop worsening nausea, chest tightness, cough, lightheadedness, and the sensation that her throat closing. She took PO Benadryl 25mg; however, her symptoms were not alleviated. She was subsequently evaluated in the ED.   ? Received PO Benadryl 25mg, IV Benadryl 25mg, Epinephrine 0.3mg x 2, IV Famotidine 20mg, IV Solumedrol 125mg & 60mg, DuoNebs x 3, Racepinephrine x 1.

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