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This is VAERS ID 1460011

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1460011
VAERS Form:2
Age:46.0
Sex:Male
Location:Michigan
Vaccinated:2021-03-31
Onset:2021-07-03
Submitted:0000-00-00
Entered:2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 2 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Fatigue, Pyrexia, Influenza A virus test, Influenza B virus test, COVID-19, SARS-CoV-2 test positive

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Sensipar, Pepcid, Cellcept, Deltason, Demadex
Current Illness:
Preexisting Conditions: major depression, stage 3a kidney disease, status post kidney transplant, hyperlipidemia, chronic back pain
Allergies: codeine, hydrocodone-acetaminophen, sevelamer, tomato
Diagnostic Lab Data: SARS-CoV-2 and influenza AB antigens, POC positive for SARS on 7/3/21
CDC 'Split Type':

Write-up: Pt received Moderna vaccines on 3/31/21 and 4/28/21. Pt presented to the ED with complaints of diffused fatigue and fever. On 7/3/21 pt was found to be COVID-19 positive.

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