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This is VAERS ID 1704791

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1704791
VAERS Form:2
Age:88.0
Sex:Female
Location:Arizona
Vaccinated:2021-09-09
Onset:2021-09-11
Submitted:0000-00-00
Entered:2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Erythema

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: no
Current Illness: no
Preexisting Conditions: chronic leukemia
Allergies: penicillin, grass, dust, perfumes
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: left arm turn red a streak down front of her arm

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1704791&WAYBACKHISTORY=ON


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