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From the 10/15/2021 release of VAERS data:

This is VAERS ID 906999



Case Details

VAERS ID: 906999 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Unknown  
Location: Colorado  
Vaccinated:2020-12-22
Onset:2020-12-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Lip swelling, Paraesthesia oral
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: mild swelling and tingeling sensation of the lips. No significant swelling.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=906999

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