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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1374505



Case Details

VAERS ID: 1374505 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Kentucky  
Vaccinated:1989-04-01
Onset:2021-06-01
   Days after vaccination:11749
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Fatigue, Injection site bruising, Injection site erythema, Injection site mass, Injection site pain, Tachycardia, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: details unclear but did not include anaphylaxis or other severe reaction
Other Medications: unknown
Current Illness: none
Preexisting Conditions: endometriosis, PCOS
Allergies: unknown
Diagnostic Lab Data: none at this time
CDC Split Type:

Write-up: bruise then knot at injection site with large painful spreading redness; extreme fatigue, tachycardia, wheezing, weakness


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1374505


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