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This is VAERS ID 1257415

History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 1257415
VAERS Form:2
Age:43.0
Sex:Female
Location:California
Vaccinated:2021-04-09
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Erythema, Pain, Skin warm, Injected limb mobility decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, vitamin e, collagen+ c.
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data: Emergency room on 4/20/2021, day 11 after shot. Unable to move arm.
CDC 'Split Type':

Write-up: Severe pain, redness, warmth. Unable to move arm/ shoulder on day 4 after shot. Unable to lift, carry, raise arm above head. Increasing pain, warmth and redness continue on day 15 after shot. Continued immobility on day 15 after shot.


Changed on 5/14/2021

VAERS ID: 1257415 Before After
VAERS Form:2
Age:43.0
Sex:Female
Location:California
Vaccinated:2021-04-09
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Erythema, Pain, Skin warm, Injected limb mobility decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, vitamin e, collagen+ c.
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: N/a N/a
Diagnostic Lab Data: Emergency room on 4/20/2021, day 11 after shot. Unable to move arm.
CDC 'Split Type':

Write-up: Severe pain, redness, warmth. Unable to move arm/ shoulder on day 4 after shot. Unable to lift, carry, raise arm above head. Increasing pain, warmth and redness continue on day 15 after shot. Continued immobility on day 15 after shot.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1257415&WAYBACKHISTORY=ON


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