National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1378155

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1378155
VAERS Form:2
Age:52.0
Sex:Female
Location:Indiana
Vaccinated:2021-06-03
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Chest pain, Chills, Erythema, Headache, Pruritus, Pyrexia, Vaccination site pain, Vaccination site swelling, Vaccination site warmth

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Multivitamin
Current Illness: Covid-19
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Swelling, itching, pain, burning, redness, and warm to the touch at vaccination site on upper left arm. Fever fluctuating between 100 and 102 lasting 3 days. Headache for 3 days. Chills on first day of symptoms lasting about 10 hours. Sporadic pain in center of chest on second day of symptoms lasting about 8 hours.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1378155&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166