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This is VAERS ID 1376041

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1376041
VAERS Form:2
Age:31.0
Sex:Female
Location:Missouri
Vaccinated:1989-09-13
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chills, Dizziness, Erythema, Vertigo, 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: unknown
Current Illness: asthma
Preexisting Conditions: asthma
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt''s mom called and pt had chills and red swollen arms. told her this is normal but she is complaining of dizziness. she does have vertigo.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1376041&WAYBACKHISTORY=ON


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