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This is VAERS ID 920834

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 920834
VAERS Form:2
Age:18.0
Sex:Female
Location:New York
Vaccinated:2021-01-05
Onset:2021-01-05
Submitted:0000-00-00
Entered:2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Body temperature increased, Flushing

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: PCN, peanuts, pomegranate, strawberry
Diagnostic Lab Data: sent to ED
CDC 'Split Type':

Write-up: Generalized flushing, increase body temp


Changed on 5/7/2021

VAERS ID: 920834 Before After
VAERS Form:2
Age:18.0
Sex:Female
Location:New York
Vaccinated:2021-01-05
Onset:2021-01-05
Submitted:0000-00-00
Entered:2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Body temperature increased, Flushing

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: PCN, peanuts, pomegranate, strawberry strawberry
Diagnostic Lab Data: sent to ED
CDC 'Split Type':

Write-up: Generalized flushing, increase body temp


Changed on 5/21/2021

VAERS ID: 920834 Before After
VAERS Form:2
Age:18.0
Sex:Female
Location:New York
Vaccinated:2021-01-05
Onset:2021-01-05
Submitted:0000-00-00
Entered:2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Body temperature increased, Flushing

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: PCN, peanuts, pomegranate, strawberry strawberry
Diagnostic Lab Data: sent to ED
CDC 'Split Type':

Write-up: Generalized flushing, increase body temp

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