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This is VAERS ID 1714675

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/24/2021

VAERS ID: 1714675
VAERS Form:2
Age:25.0
Sex:Female
Location:Unknown
Vaccinated:2021-09-10
Onset:2021-09-10
Submitted:0000-00-00
Entered:2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 2 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Chills, Dyspnoea, Headache

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20213

Write-up: Difficult to breathing; Chills; Headache; This spontaneous case was reported by a consumer and describes the occurrence of DYSPNOEA (Difficult to breathing), CHILLS (Chills) and HEADACHE (Headache) in a 25-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 014F21A) for COVID-19 vaccination. No Medical History information was reported. On 10-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 10-Sep-2021, the patient experienced DYSPNOEA (Difficult to breathing), CHILLS (Chills) and HEADACHE (Headache). At the time of the report, DYSPNOEA (Difficult to breathing), CHILLS (Chills) and HEADACHE (Headache) outcome was unknown. No concomitant medication reported. No treatment information was provided

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