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This is VAERS ID 1377795

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1377795
VAERS Form:2
Age:38.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-02-16
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 - / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Fatigue, Parosmia, Pulmonary congestion, Taste disorder, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: bupropion, Nuvaring, fluticasone Nasal, Advair Diskus
Current Illness:
Preexisting Conditions: Frequent headaches, asthma, hypercholesterolemia, chronic neck pain, depression with anxiety, seasonal allergies, LGSIL on pap smear of cervix.
Allergies: Vicodin, environmental (unspecified)
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt received both doses of the Moderna COVID-19 vaccines, one on 1/19/21 and the second on 2/16. No lot number is located either in patient chart or state vaccine electronic registry (WIR). For location, there was only a number listed, "11029", on both entries. Writer will be unable to obtain any further vaccination information. Pt then tested positive after a trip. Pt was negative on 5/27/21, and then tested positive via PCR on 6/4/2021 at an outpatient drive through testing site. Pt reports chest congestion, altered taste and smell, and fatigue, since 5/31/2021. No other symptoms, pt was not ill enough to be hospitalized. Sample will be submitted via state testing for variant testing.

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