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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1749796

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Case Details

VAERS ID: 1749796 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-03-01
Onset:2021-09-13
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Headache, Influenza A virus test negative, Influenza B virus test, Respiratory syncytial virus test negative, SARS-CoV-2 test negative, Sneezing
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Sep 13, 2021@16:36:49 FLU A (CEPHEID) NEGATIVE, FLU B (CEPHEID) NEGATIVE, RSV (CEPHEID) NEGATIVE COVID-19 (CEPHEID) POSITIVEA*
CDC Split Type:

Write-up: C/o headache, cough, sneezing off/on x1 wk.


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