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This is VAERS ID 1371359

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371359
VAERS Form:2
Age:26.0
Sex:Male
Location:California
Vaccinated:2021-06-01
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Chills, Headache, Myalgia, Pyrexia, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: None
Current Illness: None
Preexisting Conditions: No
Allergies: None
Diagnostic Lab Data: Covid-19 test: Negative 6/3/2021
CDC 'Split Type':

Write-up: Fever, Headache, Shivering, and muscle pain

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