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This is VAERS ID 907194

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 907194
VAERS Form:2
Age:61.0
Sex:Male
Location:Connecticut
Vaccinated:2020-12-22
Onset:2020-12-22
Submitted:0000-00-00
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Arthralgia, Chills, Fatigue, Headache, Myalgia, Pyrexia

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: Aspirin, Lopressor, Lisinipril/HCTZ, Rosuvastatin
Current Illness: None
Preexisting Conditions: CAD, HTN
Allergies: None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Moderna COVID-19 Vaccine- Fever, Chills, Muscle and joint aches, headache, fatigue. Self limiting, went to bed and woke feeling better. Only fatigue now.


Changed on 5/7/2021

VAERS ID: 907194 Before After
VAERS Form:2
Age:61.0
Sex:Male
Location:Connecticut
Vaccinated:2020-12-22
Onset:2020-12-22
Submitted:0000-00-00
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Arthralgia, Chills, Fatigue, Headache, Myalgia, Pyrexia

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: Aspirin, Lopressor, Lisinipril/HCTZ, Rosuvastatin
Current Illness: None
Preexisting Conditions: CAD, HTN
Allergies: None None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Moderna COVID-19 Vaccine- Fever, Chills, Muscle and joint aches, headache, fatigue. Self limiting, went to bed and woke feeling better. Only fatigue now.


Changed on 5/14/2021

VAERS ID: 907194 Before After
VAERS Form:2
Age:61.0
Sex:Male
Location:Connecticut
Vaccinated:2020-12-22
Onset:2020-12-22
Submitted:0000-00-00
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Arthralgia, Chills, Fatigue, Headache, Myalgia, Pyrexia

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: Aspirin, Lopressor, Lisinipril/HCTZ, Rosuvastatin
Current Illness: None
Preexisting Conditions: CAD, HTN
Allergies: None None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Moderna COVID-19 Vaccine- Fever, Chills, Muscle and joint aches, headache, fatigue. Self limiting, went to bed and woke feeling better. Only fatigue now.

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