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This is VAERS ID 1421846

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1421846
VAERS Form:2
Age:66.0
Sex:Female
Location:California
Vaccinated:2021-06-03
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Abdominal distension, Fluid retention, Peripheral swelling, Renal impairment

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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: DM, HTN
Allergies: Diclofenac
Diagnostic Lab Data: At the hospital kidney function was low compared to last year that was normal.
CDC 'Split Type':

Write-up: Swelling of the legs and bloating of stomach, fluid retention

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