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This is VAERS ID 1368725

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1368725
VAERS Form:2
Age:36.0
Sex:Female
Location:Colorado
Vaccinated:2021-04-28
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Antinuclear antibody negative, Differential white blood cell count, Lymphocyte count, Platelet count, Rheumatoid factor negative, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: Ambien, Ativan, Birth Control.
Current Illness: None
Preexisting Conditions: No
Allergies: None
Diagnostic Lab Data: Basic blood tests done on 5/26, CBC with differential/platelet, comp metabolic panel (14), with the results of high lymphs, Rheumatoid arthritis factor less then 10 for current result and flag. direct negative.
CDC 'Split Type':

Write-up: Moderna COVID?19 Vaccine EUA

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