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This is VAERS ID 1425021

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1425021
VAERS Form:2
Age:42.0
Sex:Female
Location:Tennessee
Vaccinated:2021-06-11
Onset:2021-06-20
Submitted:0000-00-00
Entered:2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Injection site erythema, Injection site mass, Injection site pruritus, Injection site swelling

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: PROPRANOLOL ER 80 MG, PANTOPRAZOLE DR 40MG, ATORVASTATIN 20 MG
Current Illness:
Preexisting Conditions: GERD, HIGH CHOLESTEROL
Allergies: SULFA CLARITHROMYCIN, CODIENE, OPIOIDS
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: COVID ARM- PATIENT DEVELOPED A RED, SWOLLEN, ITCHY LUMP AT INJECTION SITE WEEKS AFTER VACCINATION

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