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This is VAERS ID 907525

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 907525
VAERS Form:1
Age:72.0
Sex:Male
Location:Pennsylvania
Vaccinated:2020-12-22
Onset:2020-12-23
Submitted:2020-12-23
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 2 LA / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Confusional state, Hypertension, Pyrexia, SARS-CoV-2 test positive

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient covid +,on day 13 since identified. received covid 19 vaccine 19 hours prior to fever presentation. patient to receive full medical work up to rule out other medical contributions for fever. Confusion, Fever, HYPERtension & FEVER 101.5 fahrenheit, weakness


Changed on 5/7/2021

VAERS ID: 907525 Before After
VAERS Form:1
Age:72.0
Sex:Male
Location:Pennsylvania
Vaccinated:2020-12-22
Onset:2020-12-23
Submitted:2020-12-23
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 2 LA / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Confusional state, Hypertension, Pyrexia, SARS-CoV-2 test positive

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient covid +,on day 13 since identified. received covid 19 vaccine 19 hours prior to fever presentation. patient to receive full medical work up to rule out other medical contributions for fever. Confusion, Fever, HYPERtension & FEVER 101.5 fahrenheit, weakness


Changed on 5/14/2021

VAERS ID: 907525 Before After
VAERS Form:1
Age:72.0
Sex:Male
Location:Pennsylvania
Vaccinated:2020-12-22
Onset:2020-12-23
Submitted:2020-12-23
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 2 LA / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Confusional state, Hypertension, Pyrexia, SARS-CoV-2 test positive

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient covid +,on day 13 since identified. received covid 19 vaccine 19 hours prior to fever presentation. patient to receive full medical work up to rule out other medical contributions for fever. Confusion, Fever, HYPERtension & FEVER 101.5 fahrenheit, weakness

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