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This is VAERS ID 1437417

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1437417
VAERS Form:2
Age:68.0
Sex:Female
Location:Arkansas
Vaccinated:2021-06-29
Onset:2021-06-29
Submitted:0000-00-00
Entered:2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chills, Diarrhoea, Dizziness, Gait disturbance, Headache, Myalgia, Nausea, Pyrexia, Retching, Joint range of motion decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Xanax, Furosemide, Lexapro, Albuterol, Metformin, Lisinopril, Amlodipine, Triamcinolone
Current Illness: none
Preexisting Conditions: Diabetes Mellitus type II, Anxiety, Hypertension
Allergies: Crestor, Hctz, Td toxoid, Talwin, Sulfa, Penicillins, Novocain, Norgesic Forte, Codeine
Diagnostic Lab Data: none at this time
CDC 'Split Type':

Write-up: Patient experienced chills and fever for hours, Nausea with dry heaves, Diarrhea, severe Headache, Dizziness , staggering gait, myalgia causing difficulty in raising her or moving left arm---patient advised that she could treat signs and symptoms, which started 11pm the night before and continued at time of her call to the office to report adverse reactions at 10 am on 6/30/21

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1437417&WAYBACKHISTORY=ON


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