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This is VAERS ID 1440955

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1440955
VAERS Form:2
Age:54.0
Sex:Female
Location:Unknown
Vaccinated:2021-05-20
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / UNK UN / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Psychotic disorder

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)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had several visits to the ED within 6 weeks of receiving COVID vaccination. She presented to the ED on 6/4/2021 for paranoid psychosis. She presented to the ED on 06/09/2021 and was subsequently hospitalized for amphetamine dependence.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1440955&WAYBACKHISTORY=ON


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