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This is VAERS ID 919817

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/15/2021

VAERS ID: 919817
VAERS Form:2
Age:19.0
Sex:Female
Location:Nebraska
Vaccinated:2021-01-04
Onset:2021-01-05
Submitted:0000-00-00
Entered:2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Nausea, Pain, Pyrexia

Life Threatening? No
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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol and Motrin; Singulair, Nexplanon implant
Current Illness: None
Preexisting Conditions: Asthma, seasonal allergies
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Fever, nausea, body aches


Changed on 5/7/2021

VAERS ID: 919817 Before After
VAERS Form:2
Age:19.0
Sex:Female
Location:Nebraska
Vaccinated:2021-01-04
Onset:2021-01-05
Submitted:0000-00-00
Entered:2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Nausea, Pain, Pyrexia

Life Threatening? No
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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol and Motrin; Singulair, Nexplanon implant
Current Illness: None
Preexisting Conditions: Asthma, seasonal allergies
Allergies: NKDA NKDA
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Fever, nausea, body aches


Changed on 5/14/2021

VAERS ID: 919817 Before After
VAERS Form:2
Age:19.0
Sex:Female
Location:Nebraska
Vaccinated:2021-01-04
Onset:2021-01-05
Submitted:0000-00-00
Entered:2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Nausea, Pain, Pyrexia

Life Threatening? No
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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol and Motrin; Singulair, Nexplanon implant
Current Illness: None
Preexisting Conditions: Asthma, seasonal allergies
Allergies: NKDA NKDA
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Fever, nausea, body aches

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