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This is VAERS ID 1371783

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371783
VAERS Form:2
Age:69.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-04-01
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: COVID-19, SARS-CoV-2 test positive

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: na
Current Illness: na
Preexisting Conditions: na
Allergies: na
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was diagnosed with COVID-19 on 06/01/2021

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1371783&WAYBACKHISTORY=ON


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