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This is VAERS ID 921553

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 921553
VAERS Form:2
Age:19.0
Sex:Female
Location:Texas
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 025J20-2A / 1 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Erythema, Hypersensitivity, Pruritus, Skin warm

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 19 yo female received COVID Vaccines at 0930, reported to Primary care around 1200 pm with pruritus, erythema and warmth on upper extremities, chest and back. Airway intact, Lungs CTA bilar, NEURO WNL, VS wnl. Will tx for mild allergic reaction, Educated on Anaphylaxis protocol. SM v/u


Changed on 5/7/2021

VAERS ID: 921553 Before After
VAERS Form:2
Age:19.0
Sex:Female
Location:Texas
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 025J20-2A / 1 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Erythema, Hypersensitivity, Pruritus, Skin warm

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKA NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 19 yo female received COVID Vaccines at 0930, reported to Primary care around 1200 pm with pruritus, erythema and warmth on upper extremities, chest and back. Airway intact, Lungs CTA bilar, NEURO WNL, VS wnl. Will tx for mild allergic reaction, Educated on Anaphylaxis protocol. SM v/u


Changed on 5/21/2021

VAERS ID: 921553 Before After
VAERS Form:2
Age:19.0
Sex:Female
Location:Texas
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 025J20-2A / 1 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Erythema, Hypersensitivity, Pruritus, Skin warm

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKA NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 19 yo female received COVID Vaccines at 0930, reported to Primary care around 1200 pm with pruritus, erythema and warmth on upper extremities, chest and back. Airway intact, Lungs CTA bilar, NEURO WNL, VS wnl. Will tx for mild allergic reaction, Educated on Anaphylaxis protocol. SM v/u

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