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This is VAERS ID 912960

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 912960
VAERS Form:2
Age:19.0
Sex:Female
Location:Arkansas
Vaccinated:2020-12-28
Onset:2020-12-29
Submitted:0000-00-00
Entered:2020-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / UNK LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Chills, Headache

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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: headache/chills/weakness


Changed on 5/7/2021

VAERS ID: 912960 Before After
VAERS Form:2
Age:19.0
Sex:Female
Location:Arkansas
Vaccinated:2020-12-28
Onset:2020-12-29
Submitted:0000-00-00
Entered:2020-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / UNK LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Chills, Headache

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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown unknown
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: headache/chills/weakness


Changed on 5/14/2021

VAERS ID: 912960 Before After
VAERS Form:2
Age:19.0
Sex:Female
Location:Arkansas
Vaccinated:2020-12-28
Onset:2020-12-29
Submitted:0000-00-00
Entered:2020-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / UNK LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Chills, Headache

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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown unknown
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: headache/chills/weakness

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=912960&WAYBACKHISTORY=ON


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