National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1775945

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1775945
VAERS Form:2
Age:71.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-03-01
Onset:2021-09-30
Submitted:0000-00-00
Entered:2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Fatigue, Vaccination site pain

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Rheumatic fever (as a kid)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20213

Write-up: Mild soreness at the injection site; I was really, really tired & fatigued; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE PAIN (Mild soreness at the injection site) and FATIGUE (I was really, really tired & fatigued) in a 71-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Rheumatic fever (as a kid). In March 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Sep-2021, the patient experienced VACCINATION SITE PAIN (Mild soreness at the injection site) and FATIGUE (I was really, really tired & fatigued). At the time of the report, VACCINATION SITE PAIN (Mild soreness at the injection site) and FATIGUE (I was really, really tired & fatigued) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication information was provided. No treatment medication information was provided. Patient hip replacement surgery scheduled in October and doctors had recommended it. the patient experiencing mild soreness at the injection site and was really, really tired and fatigued. Most recent FOLLOW-UP information incorporated above includes: On 30-Sep-2021: Upon follow-up source document contain future surgery details updated in Inarrative supplement.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1775945&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166