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This is VAERS ID 987979

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 987979
VAERS Form:2
Age:80.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-01-11
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Injection site pruritus, Injection site reaction, Petechiae, Rash erythematous

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: Tylenol #3, amlodipine, fenofibrate, vitamin D
Current Illness:
Preexisting Conditions: osteoporosis, pernicious anemia
Allergies: iodine contrast media, tetracycline
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Flat red rash approximately 3 inches in diameter surrounding injection site (looked like petechiae) with extreme itching for 2-3 days. Notified appropriate local site to report reaction. No more symptoms after 3 days. Unknown if caused by the Covid vaccine as it occurred 8 days after injection.


Changed on 5/7/2021

VAERS ID: 987979 Before After
VAERS Form:2
Age:80.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-01-11
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Injection site pruritus, Injection site reaction, Petechiae, Rash erythematous

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: Tylenol #3, amlodipine, fenofibrate, vitamin D
Current Illness:
Preexisting Conditions: osteoporosis, pernicious anemia
Allergies: iodine contrast media, tetracycline tetracycline
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Flat red rash approximately 3 inches in diameter surrounding injection site (looked like petechiae) with extreme itching for 2-3 days. Notified appropriate local site to report reaction. No more symptoms after 3 days. Unknown if caused by the Covid vaccine as it occurred 8 days after injection.


Changed on 5/14/2021

VAERS ID: 987979 Before After
VAERS Form:2
Age:80.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-01-11
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Injection site pruritus, Injection site reaction, Petechiae, Rash erythematous

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: Tylenol #3, amlodipine, fenofibrate, vitamin D
Current Illness:
Preexisting Conditions: osteoporosis, pernicious anemia
Allergies: iodine contrast media, tetracycline tetracycline
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Flat red rash approximately 3 inches in diameter surrounding injection site (looked like petechiae) with extreme itching for 2-3 days. Notified appropriate local site to report reaction. No more symptoms after 3 days. Unknown if caused by the Covid vaccine as it occurred 8 days after injection.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=987979&WAYBACKHISTORY=ON

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