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This is VAERS ID 953594

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 953594
VAERS Form:2
Age:49.0
Sex:Female
Location:Michigan
Vaccinated:2021-01-06
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Lymphadenopathy, Pain, Pulmonary embolism, 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: Flu Vaccine reported lymphadenopathy over 25 years ago.
Other Medications: None
Current Illness: None Reported
Preexisting Conditions: Reported today history of Pulmonary Embolism 4 years ago.
Allergies: None Reported
Diagnostic Lab Data: Found "small P.E." per client on visit to ER 1/15/2021
CDC 'Split Type':

Write-up: Vaccinated 1/6/2021. No issues reported per client until day 5, 1/11/2021. Reports lymphadenopathy, axillary area, left side, left breast area and chest. Reports some swelling noted lymph nodes right axillary and sore to touch. Report fever onset 1/11, 1/12, 1/13. Then Thursday 1/14/2021 contacted PCP and was told on 1/15/2021 to see medical evaluation. Reports on 1/15/2021 went to ER and was evaluated. Reports lymphadenopathy and "small P.E." found. Unsure if incidental as history of P.E. 4 years ago. Also reports over 25 years ago had lymphadenopathy from Flu Vaccine and has not had any vaccines prior to this COVID-19 vaccine. Reports discharged same day to home with Topical Benadryl Cream for redness and itching at site of injection which per client also did not start until day #5 after vaccination. Reports no issues prior to day #5 post vaccination. Home and doing better but with continued lymphadenopathy left side axillary, breast and chest area. Denies any follow-up appointments other than a request to talk w/LHD Doctor to see if she should get vaccine #2. This RN will relay to MD for advisement/consult.


Changed on 5/7/2021

VAERS ID: 953594 Before After
VAERS Form:2
Age:49.0
Sex:Female
Location:Michigan
Vaccinated:2021-01-06
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Lymphadenopathy, Pain, Pulmonary embolism, 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: Flu Vaccine reported lymphadenopathy over 25 years ago.
Other Medications: None
Current Illness: None Reported
Preexisting Conditions: Reported today history of Pulmonary Embolism 4 years ago.
Allergies: None Reported Reported
Diagnostic Lab Data: Found "small P.E." per client on visit to ER 1/15/2021
CDC 'Split Type':

Write-up: Vaccinated 1/6/2021. No issues reported per client until day 5, 1/11/2021. Reports lymphadenopathy, axillary area, left side, left breast area and chest. Reports some swelling noted lymph nodes right axillary and sore to touch. Report fever onset 1/11, 1/12, 1/13. Then Thursday 1/14/2021 contacted PCP and was told on 1/15/2021 to see medical evaluation. Reports on 1/15/2021 went to ER and was evaluated. Reports lymphadenopathy and "small P.E." found. Unsure if incidental as history of P.E. 4 years ago. Also reports over 25 years ago had lymphadenopathy from Flu Vaccine and has not had any vaccines prior to this COVID-19 vaccine. Reports discharged same day to home with Topical Benadryl Cream for redness and itching at site of injection which per client also did not start until day #5 after vaccination. Reports no issues prior to day #5 post vaccination. Home and doing better but with continued lymphadenopathy left side axillary, breast and chest area. Denies any follow-up appointments other than a request to talk w/LHD Doctor to see if she should get vaccine #2. This RN will relay to MD for advisement/consult.


Changed on 5/14/2021

VAERS ID: 953594 Before After
VAERS Form:2
Age:49.0
Sex:Female
Location:Michigan
Vaccinated:2021-01-06
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Lymphadenopathy, Pain, Pulmonary embolism, 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: Flu Vaccine reported lymphadenopathy over 25 years ago.
Other Medications: None
Current Illness: None Reported
Preexisting Conditions: Reported today history of Pulmonary Embolism 4 years ago.
Allergies: None Reported Reported
Diagnostic Lab Data: Found "small P.E." per client on visit to ER 1/15/2021
CDC 'Split Type':

Write-up: Vaccinated 1/6/2021. No issues reported per client until day 5, 1/11/2021. Reports lymphadenopathy, axillary area, left side, left breast area and chest. Reports some swelling noted lymph nodes right axillary and sore to touch. Report fever onset 1/11, 1/12, 1/13. Then Thursday 1/14/2021 contacted PCP and was told on 1/15/2021 to see medical evaluation. Reports on 1/15/2021 went to ER and was evaluated. Reports lymphadenopathy and "small P.E." found. Unsure if incidental as history of P.E. 4 years ago. Also reports over 25 years ago had lymphadenopathy from Flu Vaccine and has not had any vaccines prior to this COVID-19 vaccine. Reports discharged same day to home with Topical Benadryl Cream for redness and itching at site of injection which per client also did not start until day #5 after vaccination. Reports no issues prior to day #5 post vaccination. Home and doing better but with continued lymphadenopathy left side axillary, breast and chest area. Denies any follow-up appointments other than a request to talk w/LHD Doctor to see if she should get vaccine #2. This RN will relay to MD for advisement/consult.

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