National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 930455

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 930455
VAERS Form:2
Age:54.0
Sex:Female
Location:Tennessee
Vaccinated:2020-12-29
Onset:2021-01-07
Submitted:0000-00-00
Entered:2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chills, Diarrhoea, Nausea, Pain, Petechiae, Tenderness

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Neurontin, Trazadone, Effexor XR, Premarin, Calcium
Current Illness: None
Preexisting Conditions: no
Allergies: Bactrim-Gi upset EES-Gi upset Lexapro-muscle aches
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Onset January 7.,2021 of nausea, diarrhea, chills and body aches that lasted about 18 hours. Noticed on vaccination arm an area of about 2x2 inches that looked like red petechial hemorrhage that is sore to palpation.


Changed on 5/7/2021

VAERS ID: 930455 Before After
VAERS Form:2
Age:54.0
Sex:Female
Location:Tennessee
Vaccinated:2020-12-29
Onset:2021-01-07
Submitted:0000-00-00
Entered:2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chills, Diarrhoea, Nausea, Pain, Petechiae, Tenderness

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Neurontin, Trazadone, Effexor XR, Premarin, Calcium
Current Illness: None
Preexisting Conditions: no
Allergies: Bactrim-Gi upset EES-Gi upset Lexapro-muscle aches aches
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Onset January 7.,2021 of nausea, diarrhea, chills and body aches that lasted about 18 hours. Noticed on vaccination arm an area of about 2x2 inches that looked like red petechial hemorrhage that is sore to palpation.


Changed on 5/14/2021

VAERS ID: 930455 Before After
VAERS Form:2
Age:54.0
Sex:Female
Location:Tennessee
Vaccinated:2020-12-29
Onset:2021-01-07
Submitted:0000-00-00
Entered:2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chills, Diarrhoea, Nausea, Pain, Petechiae, Tenderness

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Neurontin, Trazadone, Effexor XR, Premarin, Calcium
Current Illness: None
Preexisting Conditions: no
Allergies: Bactrim-Gi upset EES-Gi upset Lexapro-muscle aches aches
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Onset January 7.,2021 of nausea, diarrhea, chills and body aches that lasted about 18 hours. Noticed on vaccination arm an area of about 2x2 inches that looked like red petechial hemorrhage that is sore to palpation.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=930455&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166