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This is VAERS ID 1757172

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1757172
VAERS Form:2
Age:86.0
Sex:Male
Location:Minnesota
Vaccinated:2021-02-11
Onset:2021-09-30
Submitted:0000-00-00
Entered:2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 2 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Cough, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Asprin; Smivastatin, Amlodipine; Metorprolo; Furosemide; Fluconionide
Current Illness: none
Preexisting Conditions: hypertension; hyperlipidemia, chronic kidney disease, stage 3; hyperthyroidism;peripheral vascular disease
Allergies: tamsulosin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient has tested positive for Covid. Only symptoms, small non-productive cough, and slightly weak. symptoms starting 9/29/21

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