National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1378754

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1378754
VAERS Form:2
Age:59.0
Sex:Female
Location:New Jersey
Vaccinated:2021-05-29
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Headache, Pain, Pyrexia, Ultrasound Doppler abnormal, Deep vein thrombosis, Computerised tomogram head, Computerised tomogram thorax abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: HTN
Allergies: None
Diagnostic Lab Data: CT Scan Head/CT Chest/US Leg
CDC 'Split Type':

Write-up: Headache, dizziness, pain, aches and fever. DVT in right leg causing extreme, unbearable pain. Has never had history of clotting.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1378754&WAYBACKHISTORY=ON


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