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This is VAERS ID 1475855

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1475855
VAERS Form:2
Age:21.0
Sex:Male
Location:Unknown
Vaccinated:2021-07-13
Onset:2021-07-15
Submitted:0000-00-00
Entered:2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Back pain, Chills, Dizziness, Headache, Nausea, Vaccination complication, Emotional distress

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: UNK
Current Illness: N/A
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: ROS: General: No fever, + chills HEENT: no Eye redness, no visual disturbance; no Ear pain, no rhinorrhea, no Mouth lesions, no sore throat; no Facial pain; no Neck pain Pulmonary: no shortness of breath, no cough, no chest wall lesions Cardiovascular: no chest pain, no extremity coolness, no cyanosis, no new edema Abdomen: no abdominal pain, + nausea, no vomiting, no diarrhea GU: no dysuria, no hematuria Musculoskeletal: no limited ROM; no extremity pain; +low back pain Neuro: + headache, no new numbness/tingling, no new weakness, no speech disturbance, no balance issue Skin: no new rash All systems were reviewed and negative except as noted above Physical exam: General: Patient appears to be in mild distress HEENT: normal conjunctivae and PERRL; no rhinorrhea; no facial swelling; normal voice; no nystagmus or photophobia or Horner Neck: no overt swelling. Neck supple. Pulmonary: normal work of breathing; Abdomen: abdomen soft, non-tender, without guarding. No abnormal distention Extremities: no edema; normal ROMs of extremities Skin: warm extremities Neuro: alert, with normal attention. Face symmetrical. Normal motor movements of extremities. No paresthesia. Normal speech and no evidence of truncal or appendicular ataxia Psych: normal mood Assessment and Plan: suspected adverse reaction from COVID-19 vaccine and very low suspicion for acute COVID-19 infection. Will treat symptomatically for now.
CDC 'Split Type':

Write-up: History: pt had 2nd Moderna COVID-19 vaccine yesterday at 10am and since yesterday evening, pt has had chills, headache, dizziness, low back pain, and nausea. Took Tylenol at 0030. Pt denies runny nose, overt fever, cough, sore throat, vomit, diarrhea, rash, sick contact, visit to Area II or contact with COVID-19 hotspot/cases in last 2 weeks and no co-morbidities.

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