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This is VAERS ID 906416

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 906416
VAERS Form:2
Age:65.0
Sex:Male
Location:Texas
Vaccinated:2020-12-21
Onset:2020-12-21
Submitted:0000-00-00
Entered:2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Body temperature increased, Fatigue, Headache, Myalgia

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: synthroid 100 mcg tamsulosin 0.4 mg esomeprozole 40 mg duloxetine 60 mg
Current Illness: none
Preexisting Conditions: none
Allergies: nkda
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: PT states he began feeling tired the afternoon of the vaccination, approx 1500. He rested and woke during the night at 2am with temp of 103.0 and headache, muscle aches. Temp at 3 am was 100.7 and headache/muscle aches. Temp 0900 was 100.0 with headache/muscle aches. Pt denies nausea, vomiting, sore throat. will continue to monitor


Changed on 5/7/2021

VAERS ID: 906416 Before After
VAERS Form:2
Age:65.0
Sex:Male
Location:Texas
Vaccinated:2020-12-21
Onset:2020-12-21
Submitted:0000-00-00
Entered:2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Body temperature increased, Fatigue, Headache, Myalgia

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: synthroid 100 mcg tamsulosin 0.4 mg esomeprozole 40 mg duloxetine 60 mg
Current Illness: none
Preexisting Conditions: none
Allergies: nkda nkda
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: PT states he began feeling tired the afternoon of the vaccination, approx 1500. He rested and woke during the night at 2am with temp of 103.0 and headache, muscle aches. Temp at 3 am was 100.7 and headache/muscle aches. Temp 0900 was 100.0 with headache/muscle aches. Pt denies nausea, vomiting, sore throat. will continue to monitor


Changed on 5/14/2021

VAERS ID: 906416 Before After
VAERS Form:2
Age:65.0
Sex:Male
Location:Texas
Vaccinated:2020-12-21
Onset:2020-12-21
Submitted:0000-00-00
Entered:2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Body temperature increased, Fatigue, Headache, Myalgia

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: synthroid 100 mcg tamsulosin 0.4 mg esomeprozole 40 mg duloxetine 60 mg
Current Illness: none
Preexisting Conditions: none
Allergies: nkda nkda
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: PT states he began feeling tired the afternoon of the vaccination, approx 1500. He rested and woke during the night at 2am with temp of 103.0 and headache, muscle aches. Temp at 3 am was 100.7 and headache/muscle aches. Temp 0900 was 100.0 with headache/muscle aches. Pt denies nausea, vomiting, sore throat. will continue to monitor

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=906416&WAYBACKHISTORY=ON

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