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This is VAERS ID 919721

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 919721
VAERS Form:2
Age:46.0
Sex:Female
Location:Iowa
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Facial paralysis, Hypoaesthesia, Paraesthesia oral

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Chocolate, INH
Diagnostic Lab Data: 12/31/20: Follow up with PCP who sent me to Medical Center for possible stroke.
CDC 'Split Type':

Write-up: Tingling in lips 10 minutes after shot administered. Progressive numbness and mild drooping to right side of face (cheek, jaw, chin, neck, tongue, throat). Numbness in right arm down to 3rd, 4th and 5th fingers. Full function was still intact.


Changed on 5/7/2021

VAERS ID: 919721 Before After
VAERS Form:2
Age:46.0
Sex:Female
Location:Iowa
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Facial paralysis, Hypoaesthesia, Paraesthesia oral

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Chocolate, INH INH
Diagnostic Lab Data: 12/31/20: Follow up with PCP who sent me to Medical Center for possible stroke.
CDC 'Split Type':

Write-up: Tingling in lips 10 minutes after shot administered. Progressive numbness and mild drooping to right side of face (cheek, jaw, chin, neck, tongue, throat). Numbness in right arm down to 3rd, 4th and 5th fingers. Full function was still intact.


Changed on 5/14/2021

VAERS ID: 919721 Before After
VAERS Form:2
Age:46.0
Sex:Female
Location:Iowa
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Facial paralysis, Hypoaesthesia, Paraesthesia oral

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Chocolate, INH INH
Diagnostic Lab Data: 12/31/20: Follow up with PCP who sent me to Medical Center for possible stroke.
CDC 'Split Type':

Write-up: Tingling in lips 10 minutes after shot administered. Progressive numbness and mild drooping to right side of face (cheek, jaw, chin, neck, tongue, throat). Numbness in right arm down to 3rd, 4th and 5th fingers. Full function was still intact.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=919721&WAYBACKHISTORY=ON


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