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This is VAERS ID 1762498

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1762498
VAERS Form:2
Age:59.0
Sex:Female
Location:Texas
Vaccinated:2021-10-02
Onset:2021-10-04
Submitted:0000-00-00
Entered:2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chills, Fatigue, Headache, Injection site erythema, Injection site pain, Injection site warmth, Pyrexia, Injection site swelling

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:
Current Illness:
Preexisting Conditions:
Allergies: Codeine allergy
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient experienced headache, fatigue, chills and fever for a day and a half following the vaccination. Then those symptoms went away, she then noticed a red bump/bubble slightly lower on her arm than her injection site that appeared 2 days after vaccination. The red area was warm to the touch and the patient stated slightly painful to the touch and had grown since she had first noticed it.

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