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This is VAERS ID 1470498

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1470498
VAERS Form:2
Age:43.0
Sex:Male
Location:Hawaii
Vaccinated:0000-00-00
Onset:2021-07-13
Submitted:0000-00-00
Entered:2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 LA / -

Administered by: Private      Purchased by: ??
Symptoms: Malaise, Nucleic acid 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)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Contains abnormal data SARS-COV-2, QUALITATIVE, NAA (COVID-19), LAB Status: Final result Visible to patient: Yes (kp.org) Next appt: Today at 10:10 AM in Internal Medicine Dx: SCREENING FOR CORONAVIRUS COVID-19 DI... Specimen Information: NASOPHARYNGEAL SWAB Ref Range & Units 7/13/21 12:39 PM SARS-COV-2 NAA (COVID-19) Detected Abnormal Comment: Test performed by polymerase chain reaction (PCR). This is a Nucleic Acid Amplification Test (NAAT) which is a molecular assay also known as PCR, RT-PCR, or TMA. Disclaimer: This test has not been cleared or approved. This test has been authorized under an Emergency Use Authorization (EUA) for use by authorized laboratories. Please see fact sheet for healthcare providers & fact sheet for patients posted on the Lab website.
CDC 'Split Type':

Write-up: Patient received 6/8/2021 Given 0.5 mL Lt deltoid IM MOD 034C21A Moderna COVID-19 Vaccine (EUA) History 5/4/2021 Given 0.5 mL L Deltoid IM MOD 002C21A Moderna COVID-19 Vaccine (EUA) completed full vaccination for COVID with moderna and tested positive for COVID-19 on 7/13/21 with mild COVID symptoms. His other family members also tested positive for COVID

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