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This is VAERS ID 911854

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 911854
VAERS Form:2
Age:70.0
Sex:Female
Location:Connecticut
Vaccinated:2020-12-23
Onset:2020-12-24
Submitted:0000-00-00
Entered:2020-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Back pain, Neck pain, Pain, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Losarten, pravastan, B-12
Current Illness: High blood pressure, cholestrol
Preexisting Conditions: high blood pressure, cholesterol, obesity
Allergies: allergy to pineapple skin
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: I received the vaccine shot on 12/23/20 at 3 pm. By 12/24/20, I had pain in my left arm that radiated to my neck and back on the left side. Over the past 4/5 days, I continue to have pain in my left arm, back and neck


Changed on 5/7/2021

VAERS ID: 911854 Before After
VAERS Form:2
Age:70.0
Sex:Female
Location:Connecticut
Vaccinated:2020-12-23
Onset:2020-12-24
Submitted:0000-00-00
Entered:2020-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Back pain, Neck pain, Pain, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Losarten, pravastan, B-12
Current Illness: High blood pressure, cholestrol
Preexisting Conditions: high blood pressure, cholesterol, obesity
Allergies: allergy to pineapple skin skin
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: I received the vaccine shot on 12/23/20 at 3 pm. By 12/24/20, I had pain in my left arm that radiated to my neck and back on the left side. Over the past 4/5 days, I continue to have pain in my left arm, back and neck


Changed on 5/14/2021

VAERS ID: 911854 Before After
VAERS Form:2
Age:70.0
Sex:Female
Location:Connecticut
Vaccinated:2020-12-23
Onset:2020-12-24
Submitted:0000-00-00
Entered:2020-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Back pain, Neck pain, Pain, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Losarten, pravastan, B-12
Current Illness: High blood pressure, cholestrol
Preexisting Conditions: high blood pressure, cholesterol, obesity
Allergies: allergy to pineapple skin skin
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: I received the vaccine shot on 12/23/20 at 3 pm. By 12/24/20, I had pain in my left arm that radiated to my neck and back on the left side. Over the past 4/5 days, I continue to have pain in my left arm, back and neck

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=911854&WAYBACKHISTORY=ON


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