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This is VAERS ID 1030447

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1030447
VAERS Form:2
Age:46.0
Sex:Female
Location:Ohio
Vaccinated:2021-01-25
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 2 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Arthralgia, Back pain, Burning sensation, Chills, Groin pain, Headache, Injection site pain, Myalgia, Neck pain, Pain, Pain in extremity, Pain in jaw, Pulmonary embolism, Pyrexia, Sleep disorder, Mobility decreased, Muscle tightness, Dysstasia, Musculoskeletal chest pain, Impaired work ability, Musculoskeletal discomfort, Laboratory test, Decreased appetite, Imaging procedure, Spinal pain, SARS-CoV-2 test negative

Life Threatening? Yes
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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, Lipitor, Fish Oil, D3, Black Cohosh, Melatonin
Current Illness: none
Preexisting Conditions: hypertension, hyperlipidemia
Allergies: NKA
Diagnostic Lab Data: Medical records available from treating hospital
CDC 'Split Type':

Write-up: 02/04/21-groin pain/burning, buttocks and thighs muscle tightness, unable to sit for extended period of time due to groin discomfort 02/05/21-continued groin pain, new bilateral arm/bicept muscle pain with right side worse than left 02/06/21- headache, loss of appetite, chills, shoulder/neck/jaw/hips joint pain 02/07/21-back and ribs pain with sitting or lying- unable to sleep due to extreme pain, unable to transition from lying to sitting to standing due to pain, fever 101.8, worsening of all symptoms. Employee Health contacted, instructed to obtain Covid test, results negative. 02/08/21-First day missed work. Continued worsening of pain, groin and hip pain radiating down the back of both legs to back of both knees 02/09/21- Excruciating pain, difficulty with ambulating. Seen at Emergency Department, labs and imaging obtained, informed of bilateral Pulmonary Embolisms, admitted for treatment.


Changed on 5/7/2021

VAERS ID: 1030447 Before After
VAERS Form:2
Age:46.0
Sex:Female
Location:Ohio
Vaccinated:2021-01-25
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 2 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Arthralgia, Back pain, Burning sensation, Chills, Groin pain, Headache, Injection site pain, Myalgia, Neck pain, Pain, Pain in extremity, Pain in jaw, Pulmonary embolism, Pyrexia, Sleep disorder, Mobility decreased, Muscle tightness, Dysstasia, Musculoskeletal chest pain, Impaired work ability, Musculoskeletal discomfort, Laboratory test, Decreased appetite, Imaging procedure, Spinal pain, SARS-CoV-2 test negative

Life Threatening? Yes
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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, Lipitor, Fish Oil, D3, Black Cohosh, Melatonin
Current Illness: none
Preexisting Conditions: hypertension, hyperlipidemia
Allergies: NKA NKA
Diagnostic Lab Data: Medical records available from treating hospital
CDC 'Split Type':

Write-up: 02/04/21-groin pain/burning, buttocks and thighs muscle tightness, unable to sit for extended period of time due to groin discomfort 02/05/21-continued groin pain, new bilateral arm/bicept muscle pain with right side worse than left 02/06/21- headache, loss of appetite, chills, shoulder/neck/jaw/hips joint pain 02/07/21-back and ribs pain with sitting or lying- unable to sleep due to extreme pain, unable to transition from lying to sitting to standing due to pain, fever 101.8, worsening of all symptoms. Employee Health contacted, instructed to obtain Covid test, results negative. 02/08/21-First day missed work. Continued worsening of pain, groin and hip pain radiating down the back of both legs to back of both knees 02/09/21- Excruciating pain, difficulty with ambulating. Seen at Emergency Department, labs and imaging obtained, informed of bilateral Pulmonary Embolisms, admitted for treatment.


Changed on 5/21/2021

VAERS ID: 1030447 Before After
VAERS Form:2
Age:46.0
Sex:Female
Location:Ohio
Vaccinated:2021-01-25
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 2 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Arthralgia, Back pain, Burning sensation, Chills, Groin pain, Headache, Injection site pain, Myalgia, Neck pain, Pain, Pain in extremity, Pain in jaw, Pulmonary embolism, Pyrexia, Sleep disorder, Mobility decreased, Muscle tightness, Dysstasia, Musculoskeletal chest pain, Impaired work ability, Musculoskeletal discomfort, Laboratory test, Decreased appetite, Imaging procedure, Spinal pain, SARS-CoV-2 test negative

Life Threatening? Yes
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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, Lipitor, Fish Oil, D3, Black Cohosh, Melatonin
Current Illness: none
Preexisting Conditions: hypertension, hyperlipidemia
Allergies: NKA NKA
Diagnostic Lab Data: Medical records available from treating hospital
CDC 'Split Type':

Write-up: 02/04/21-groin pain/burning, buttocks and thighs muscle tightness, unable to sit for extended period of time due to groin discomfort 02/05/21-continued groin pain, new bilateral arm/bicept muscle pain with right side worse than left 02/06/21- headache, loss of appetite, chills, shoulder/neck/jaw/hips joint pain 02/07/21-back and ribs pain with sitting or lying- unable to sleep due to extreme pain, unable to transition from lying to sitting to standing due to pain, fever 101.8, worsening of all symptoms. Employee Health contacted, instructed to obtain Covid test, results negative. 02/08/21-First day missed work. Continued worsening of pain, groin and hip pain radiating down the back of both legs to back of both knees 02/09/21- Excruciating pain, difficulty with ambulating. Seen at Emergency Department, labs and imaging obtained, informed of bilateral Pulmonary Embolisms, admitted for treatment.

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