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This is VAERS ID 1368055

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1368055
VAERS Form:2
Age:46.0
Sex:Female
Location:Tennessee
Vaccinated:2021-06-01
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 RA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Pruritus, Skin warm, Peripheral swelling

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: Eliquis 5mg 2x daily , iron tablet one daily
Current Illness: Anemia, blood clotting disorder
Preexisting Conditions: Anemia, migraine headaches, blood clotting disorder
Allergies: Penicillin, sulfa
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Swollen upper right arm, warm to the touch, itchy skin

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1368055&WAYBACKHISTORY=ON


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