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This is VAERS ID 1774955

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1774955
VAERS Form:2
Age:53.0
Sex:Female
Location:Kentucky
Vaccinated:2021-09-28
Onset:2021-09-30
Submitted:0000-00-00
Entered:2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Injection site pruritus, Pain in extremity, Mobility decreased

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Severe soreness throughout entire right arm, so strong that I was unable to use it for a full 24 hours. Followed by itching, bad itching at injection site and left shoulder that lasted around 36 hours.

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