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This is VAERS ID 1240492

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1240492
VAERS Form:2
Age:61.0
Sex:Female
Location:Oregon
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 046A21A / UNK LA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Headache, 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: Metformen, Glimiperide, atorvastatin, Bayer aspirin, vitamin D, prenatal vitamins, pro biotic,
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Fever 101.4, severe headache


Changed on 5/7/2021

VAERS ID: 1240492 Before After
VAERS Form:2
Age:61.0
Sex:Female
Location:Oregon
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 046A21A / UNK LA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Headache, 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: Metformen, Glimiperide, atorvastatin, Bayer aspirin, vitamin D, prenatal vitamins, pro biotic,
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: None None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Fever 101.4, severe headache


Changed on 5/14/2021

VAERS ID: 1240492 Before After
VAERS Form:2
Age:61.0
Sex:Female
Location:Oregon
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 046A21A / UNK LA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Headache, 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: Metformen, Glimiperide, atorvastatin, Bayer aspirin, vitamin D, prenatal vitamins, pro biotic,
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: None None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Fever 101.4, severe headache

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