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This is VAERS ID 1368027

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1368027
VAERS Form:2
Age:56.0
Sex:Male
Location:Florida
Vaccinated:2021-06-01
Onset:2021-06-02
Submitted:0000-00-00
Entered:2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 LA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Injection site pain, 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: Lisinopril, COREG, low-dose aspirin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: 100.2 fever, body aches, sore injection site.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1368027&WAYBACKHISTORY=ON


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