National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 907248

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 907248
VAERS Form:2
Age:47.0
Sex:Male
Location:Tennessee
Vaccinated:2020-12-22
Onset:2020-12-23
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: Public      Purchased by: ??
Symptoms: Body temperature increased, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: No no illnesses the previous month.
Preexisting Conditions: Unknown
Allergies: Reported a reaction to sulfa. Not hospitalized due to previous sulfa reaction.
Diagnostic Lab Data: Patient instructed to follow up with PCP concerning any follow up or testing.
CDC 'Split Type':

Write-up: Notified by girlfriend. Patient woke up this morning with arm soreness. States temperature 102.3 this am. Instructed to call primary care. Instructed patient could have COVID or flu not related to shot. Waited 30 minutes post vaccination, without complication.


Changed on 5/7/2021

VAERS ID: 907248 Before After
VAERS Form:2
Age:47.0
Sex:Male
Location:Tennessee
Vaccinated:2020-12-22
Onset:2020-12-23
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: Public      Purchased by: ??
Symptoms: Body temperature increased, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: No no illnesses the previous month.
Preexisting Conditions: Unknown
Allergies: Reported a reaction to sulfa. Not hospitalized due to previous sulfa reaction. reaction.
Diagnostic Lab Data: Patient instructed to follow up with PCP concerning any follow up or testing.
CDC 'Split Type':

Write-up: Notified by girlfriend. Patient woke up this morning with arm soreness. States temperature 102.3 this am. Instructed to call primary care. Instructed patient could have COVID or flu not related to shot. Waited 30 minutes post vaccination, without complication.


Changed on 5/14/2021

VAERS ID: 907248 Before After
VAERS Form:2
Age:47.0
Sex:Male
Location:Tennessee
Vaccinated:2020-12-22
Onset:2020-12-23
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: Public      Purchased by: ??
Symptoms: Body temperature increased, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: No no illnesses the previous month.
Preexisting Conditions: Unknown
Allergies: Reported a reaction to sulfa. Not hospitalized due to previous sulfa reaction. reaction.
Diagnostic Lab Data: Patient instructed to follow up with PCP concerning any follow up or testing.
CDC 'Split Type':

Write-up: Notified by girlfriend. Patient woke up this morning with arm soreness. States temperature 102.3 this am. Instructed to call primary care. Instructed patient could have COVID or flu not related to shot. Waited 30 minutes post vaccination, without complication.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=907248&WAYBACKHISTORY=ON


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