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This is VAERS ID 1376597

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1376597
VAERS Form:2
Age:48.0
Sex:Female
Location:Florida
Vaccinated:2021-06-03
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chills, Diarrhoea, Dyspnoea, Nausea, Pain, Pyrexia

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None advised
Preexisting Conditions: Not known
Allergies: No known drug allergies
Diagnostic Lab Data: Not known
CDC 'Split Type':

Write-up: Breathing difficulty, Nausea, Diarrhea, Fever, Chills, Body Aches. Patient stated she had to go the emergency room on 6/4/2021

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1376597&WAYBACKHISTORY=ON


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