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|History of Changes from the VAERS Wayback Machine|
|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
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
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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