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This is VAERS ID 1034158

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1034158
VAERS Form:2
Age:77.0
Sex:Male
Location:Montana
Vaccinated:2021-02-02
Onset:2021-02-02
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Abdominal pain, Chest pain, Chills, Cough, Dizziness, Dyspnoea, Electrocardiogram, Feeling hot, Haematuria, Headache, Henoch-Schonlein purpura, Nasal congestion, Oedema, Oral discomfort, Pain, Petechiae, Proteinuria, Purpura, Rash, Rhinorrhoea, Computerised tomogram thorax, Decreased appetite, Blood test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Flonase, Metformin, losartan, flomax.
Current Illness: COVID-19 positive 01/07/2021.
Preexisting Conditions: Hypertention, irregular heart rate, diabetes.
Allergies: No known allergies.
Diagnostic Lab Data: Blood work, EKG, CT of the chest
CDC 'Split Type':

Write-up: Chills, headache, body aches, oral mucous membrane burning, runny and stuffy nose, feet "hot", cough, chest pain, difficulty breathing, crampy abdominal pain, rash - Henoch-Schonlien purpura purpura and petechiae, edema, proteinuria, hematuria, decreased appetite, dizziness


Changed on 5/7/2021

VAERS ID: 1034158 Before After
VAERS Form:2
Age:77.0
Sex:Male
Location:Montana
Vaccinated:2021-02-02
Onset:2021-02-02
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Abdominal pain, Chest pain, Chills, Cough, Dizziness, Dyspnoea, Electrocardiogram, Feeling hot, Haematuria, Headache, Henoch-Schonlein purpura, Nasal congestion, Oedema, Oral discomfort, Pain, Petechiae, Proteinuria, Purpura, Rash, Rhinorrhoea, Computerised tomogram thorax, Decreased appetite, Blood test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Flonase, Metformin, losartan, flomax.
Current Illness: COVID-19 positive 01/07/2021.
Preexisting Conditions: Hypertention, irregular heart rate, diabetes.
Allergies: No known allergies. allergies.
Diagnostic Lab Data: Blood work, EKG, CT of the chest
CDC 'Split Type':

Write-up: Chills, headache, body aches, oral mucous membrane burning, runny and stuffy nose, feet "hot", cough, chest pain, difficulty breathing, crampy abdominal pain, rash - Henoch-Schonlien purpura purpura and petechiae, edema, proteinuria, hematuria, decreased appetite, dizziness


Changed on 5/21/2021

VAERS ID: 1034158 Before After
VAERS Form:2
Age:77.0
Sex:Male
Location:Montana
Vaccinated:2021-02-02
Onset:2021-02-02
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Abdominal pain, Chest pain, Chills, Cough, Dizziness, Dyspnoea, Electrocardiogram, Feeling hot, Haematuria, Headache, Henoch-Schonlein purpura, Nasal congestion, Oedema, Oral discomfort, Pain, Petechiae, Proteinuria, Purpura, Rash, Rhinorrhoea, Computerised tomogram thorax, Decreased appetite, Blood test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Flonase, Metformin, losartan, flomax.
Current Illness: COVID-19 positive 01/07/2021.
Preexisting Conditions: Hypertention, irregular heart rate, diabetes.
Allergies: No known allergies. allergies.
Diagnostic Lab Data: Blood work, EKG, CT of the chest
CDC 'Split Type':

Write-up: Chills, headache, body aches, oral mucous membrane burning, runny and stuffy nose, feet "hot", cough, chest pain, difficulty breathing, crampy abdominal pain, rash - Henoch-Schonlien purpura purpura and petechiae, edema, proteinuria, hematuria, decreased appetite, dizziness

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