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This is VAERS ID 1382028

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1382028
VAERS Form:2
Age:39.0
Sex:Male
Location:New York
Vaccinated:2021-06-03
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Injection site pain, Pain, Impaired work ability

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None known
Allergies: None, NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had severe left shoulder/arm pain around the site of injection that continued after injection, worsened by his physical job as a custodian, he had to miss work due to this for several days, still moderate/severely painful to complete physical tasks using the left arm 5 days later (today, 6/8/21)

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1382028&WAYBACKHISTORY=ON


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