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This is VAERS ID 919827

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 919827
VAERS Form:2
Age:45.0
Sex:Male
Location:California
Vaccinated:2020-12-22
Onset:2020-12-23
Submitted:0000-00-00
Entered:2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 11J20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain lower, Abdominal pain upper, Appendicectomy, Appendicitis, Discomfort, Nausea, Pain, Computerised tomogram abdomen abnormal

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: penicillin
Diagnostic Lab Data: evaluated by urgent care physicians and determined to likely be presenting with an appendicitis. Diagnosis of acute appendicitis confirmed and surgery performed to remove appendix.
CDC 'Split Type':

Write-up: Began experiencing nausea and general stomach pains the morning after receiving the vaccine. After one day of pain and discomfort I woke the following morning (~44hrs after receiving the vaccine) to extreme acute abdominal pain in the lower right abdomen. Went to Urgent Care facility and was diagnosed by CT scan as having acute appendicitis. An emergency appendectomy was scheduled and performed for later that evening. I stayed at the Hospital overnight on 12/24/2020 post operatively on IV antibiotics to recover from the appendectomy. Was discharged from the hospital on 12/25/2020 and have been recovering for about 10 days now with limitted activity.


Changed on 5/7/2021

VAERS ID: 919827 Before After
VAERS Form:2
Age:45.0
Sex:Male
Location:California
Vaccinated:2020-12-22
Onset:2020-12-23
Submitted:0000-00-00
Entered:2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 11J20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain lower, Abdominal pain upper, Appendicectomy, Appendicitis, Discomfort, Nausea, Pain, Computerised tomogram abdomen abnormal

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: penicillin penicillin
Diagnostic Lab Data: evaluated by urgent care physicians and determined to likely be presenting with an appendicitis. Diagnosis of acute appendicitis confirmed and surgery performed to remove appendix.
CDC 'Split Type':

Write-up: Began experiencing nausea and general stomach pains the morning after receiving the vaccine. After one day of pain and discomfort I woke the following morning (~44hrs after receiving the vaccine) to extreme acute abdominal pain in the lower right abdomen. Went to Urgent Care facility and was diagnosed by CT scan as having acute appendicitis. An emergency appendectomy was scheduled and performed for later that evening. I stayed at the Hospital overnight on 12/24/2020 post operatively on IV antibiotics to recover from the appendectomy. Was discharged from the hospital on 12/25/2020 and have been recovering for about 10 days now with limitted activity.


Changed on 5/14/2021

VAERS ID: 919827 Before After
VAERS Form:2
Age:45.0
Sex:Male
Location:California
Vaccinated:2020-12-22
Onset:2020-12-23
Submitted:0000-00-00
Entered:2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 11J20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain lower, Abdominal pain upper, Appendicectomy, Appendicitis, Discomfort, Nausea, Pain, Computerised tomogram abdomen abnormal

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: penicillin penicillin
Diagnostic Lab Data: evaluated by urgent care physicians and determined to likely be presenting with an appendicitis. Diagnosis of acute appendicitis confirmed and surgery performed to remove appendix.
CDC 'Split Type':

Write-up: Began experiencing nausea and general stomach pains the morning after receiving the vaccine. After one day of pain and discomfort I woke the following morning (~44hrs after receiving the vaccine) to extreme acute abdominal pain in the lower right abdomen. Went to Urgent Care facility and was diagnosed by CT scan as having acute appendicitis. An emergency appendectomy was scheduled and performed for later that evening. I stayed at the Hospital overnight on 12/24/2020 post operatively on IV antibiotics to recover from the appendectomy. Was discharged from the hospital on 12/25/2020 and have been recovering for about 10 days now with limitted activity.

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