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This is VAERS ID 1764897

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1764897
VAERS Form:2
Age:48.0
Sex:Male
Location:Michigan
Vaccinated:2021-04-01
Onset:2021-09-30
Submitted:0000-00-00
Entered:2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A - VACCINE N / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was vaccinated with two doses of Moderna COVID-19 vaccines on 4/1/2021 and 4/29/2021, then subsequently diagnosed with positive COVID PCR on 9/30/2021 in the ED but was subsequently sent home. Patient then re-presented to the same hospital and this time was admitted on 10/4/2021.

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