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This is VAERS ID 908181

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 908181
VAERS Form:2
Age:34.0
Sex:Male
Location:New York
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 / UNK LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chills, Fatigue, Pain in extremity, Pyrexia, Tremor

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: No
Current Illness: No
Preexisting Conditions: Intermittent asthma not requiring inhaler for years
Allergies: No
Diagnostic Lab Data: No
CDC 'Split Type':

Write-up: Fever of 39. Chills shakiness severe fatigue Arm soreness


Changed on 5/7/2021

VAERS ID: 908181 Before After
VAERS Form:2
Age:34.0
Sex:Male
Location:New York
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 / UNK LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chills, Fatigue, Pain in extremity, Pyrexia, Tremor

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: No
Current Illness: No
Preexisting Conditions: Intermittent asthma not requiring inhaler for years
Allergies: No No
Diagnostic Lab Data: No
CDC 'Split Type':

Write-up: Fever of 39. Chills shakiness severe fatigue Arm soreness


Changed on 5/21/2021

VAERS ID: 908181 Before After
VAERS Form:2
Age:34.0
Sex:Male
Location:New York
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 / UNK LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chills, Fatigue, Pain in extremity, Pyrexia, Tremor

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: No
Current Illness: No
Preexisting Conditions: Intermittent asthma not requiring inhaler for years
Allergies: No No
Diagnostic Lab Data: No
CDC 'Split Type':

Write-up: Fever of 39. Chills shakiness severe fatigue Arm soreness

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