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This is VAERS ID 1240490

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1240490
VAERS Form:2
Age:44.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-04-20
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Chills, Headache, Influenza like illness, Pain, Pyrexia

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: Atorvastatin, divalproex
Current Illness:
Preexisting Conditions:
Allergies: Vicodin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Flu like symptoms, chills, body aches, headache, fever


Changed on 5/7/2021

VAERS ID: 1240490 Before After
VAERS Form:2
Age:44.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-04-20
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Chills, Headache, Influenza like illness, Pain, Pyrexia

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: Atorvastatin, divalproex
Current Illness:
Preexisting Conditions:
Allergies: Vicodin Vicodin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Flu like symptoms, chills, body aches, headache, fever


Changed on 5/14/2021

VAERS ID: 1240490 Before After
VAERS Form:2
Age:44.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-04-20
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Chills, Headache, Influenza like illness, Pain, Pyrexia

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: Atorvastatin, divalproex
Current Illness:
Preexisting Conditions:
Allergies: Vicodin Vicodin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Flu like symptoms, chills, body aches, headache, fever

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