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This is VAERS ID 1485648

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1485648
VAERS Form:2
Age:46.0
Sex:Female
Location:Florida
Vaccinated:2021-07-18
Onset:2021-07-18
Submitted:0000-00-00
Entered:2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Dyspnoea, Erythema multiforme, Rash

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? No
Previous Vaccinations:
Other Medications: None Known
Current Illness: None Known
Preexisting Conditions: None Known
Allergies: None Known
Diagnostic Lab Data: Dr diagnosed patient with Nonbullous Erythema Multiforme (695.10, L51.0) Uncomplicated
CDC 'Split Type':

Write-up: Patient reported feeling dizzy and short of breath. Went to walk-in clinic next morning after developing rash and no improvement in previous symptoms.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1485648&WAYBACKHISTORY=ON


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