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This is VAERS ID 1760971

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1760971
VAERS Form:2
Age:67.0
Sex:Male
Location:Ohio
Vaccinated:2021-09-01
Onset:2021-10-02
Submitted:0000-00-00
Entered:2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Pain in extremity, Pyrexia

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: lisinipril antrovastin
Current Illness: none
Preexisting Conditions: high blood pressure high triglycerides
Allergies: none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: common sore arm for 1 day. Pain in my hand for 1 day. Began to have a fever by 3 pm throughout the night (99.6 F) Temperature normal in late morning.

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