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This is VAERS ID 1228664

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1228664
VAERS Form:2
Age:35.0
Sex:Male
Location:Ohio
Vaccinated:2021-04-01
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 1 RA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Rash

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Scheduling dr appointment now.
CDC 'Split Type':

Write-up: Rash that resembles chicken pox on chest, torso, legs. Not very itchy. Started about 10 days after shot. Has continued to spread for 8-10 days.


Changed on 5/7/2021

VAERS ID: 1228664 Before After
VAERS Form:2
Age:35.0
Sex:Male
Location:Ohio
Vaccinated:2021-04-01
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 1 RA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Rash

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: Scheduling dr appointment now.
CDC 'Split Type':

Write-up: Rash that resembles chicken pox on chest, torso, legs. Not very itchy. Started about 10 days after shot. Has continued to spread for 8-10 days.


Changed on 5/14/2021

VAERS ID: 1228664 Before After
VAERS Form:2
Age:35.0
Sex:Male
Location:Ohio
Vaccinated:2021-04-01
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 1 RA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Rash

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: Scheduling dr appointment now.
CDC 'Split Type':

Write-up: Rash that resembles chicken pox on chest, torso, legs. Not very itchy. Started about 10 days after shot. Has continued to spread for 8-10 days.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1228664&WAYBACKHISTORY=ON


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