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This is VAERS ID 1463715

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1463715
VAERS Form:2
Age:43.0
Sex:Male
Location:California
Vaccinated:2021-06-30
Onset:2021-07-01
Submitted:0000-00-00
Entered:2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 1 LA / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Blood bilirubin increased, Dizziness, Dyspnoea, Haematocrit normal, Haemoglobin normal, Headache, Heart rate increased, Pain in extremity, Pyrexia, Rash, Red blood cell count normal, Tinnitus, Vertigo, Vision blurred, Peripheral 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: Breo 200mg Zyrtec-D Flonase
Current Illness: None
Preexisting Conditions: Cerebellar Pilocytic Astrocytoma - Successfully Removed Spontaneous Pneumo Thorax - Successfully repaired Chronic Allergies
Allergies: Levoquin Vicodine Codine
Diagnostic Lab Data: July 7th High RBC - 5.7m Hemoglobin - 17.5 HEMATOCRIT - 50.8 Bilirubin - 2.2mg
CDC 'Split Type':

Write-up: Rapid Heart Beat Blurry Vision High Fever - Approaching 2 weeks Strong Dizziness/Vertigo Rashes Week long Headaches Hard to breath Ringing in ears Deep ache/pain in leg & arm with leg swelling

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