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This is VAERS ID 1715617

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First Appeared on 9/24/2021

VAERS ID: 1715617
VAERS Form:2
Age:82.0
Sex:Male
Location:Virginia
Vaccinated:2021-09-13
Onset:2021-09-14
Submitted:0000-00-00
Entered:2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / UNK - / IM
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. - / UNK - / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Fall, Head injury, Muscular weakness, Mobility decreased, Extra dose administered, Adverse reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: MYCOPHENOLATE 250MG CAPS, SIROLIMUS 1 MG, PREDNISONE 5MG, AND OTHERS NOT KNOWN BY PHARMACY
Current Illness:
Preexisting Conditions: HISTORY OF KIDNEY TRANSPLANT
Allergies: UNKNOWN
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The patient called the pharmacy to report a bad reaction from an injection last week. Last Monday he had both the flu ad seasonal flu vaccine and his 3rd dose of Moderna Covid-19 vaccine as he is a transplant patient. He stated the following morning he got dizzy and sat down in a chair. Then fell out of the chair hitting his head but was ok from that. When he went to get up he could not move his arms and legs to roll over. He called for his wife and laid there for a while until he could work his way up to a stool and eventually a chair. He was extremely weak in his arms and could not even hold his upper body up. After about 18 hours and calling his doctor, he started to feel better. He called today a week later to report the effect. No history of bad reaction like this from previous vaccinations

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