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This is VAERS ID 919665

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 919665
VAERS Form:2
Age:28.0
Sex:Female
Location:New Jersey
Vaccinated:2020-12-29
Onset:2020-12-29
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Arthralgia, Chest X-ray, Nausea, Pyrexia, Blood test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synthroid Claritin Dexilent Terbinafine Vitamin D & B12
Current Illness:
Preexisting Conditions: Hypothyroid GERD
Allergies: Bactrim
Diagnostic Lab Data: Blood work 12/30/20 Chest X-ray 12/30/20
CDC 'Split Type':

Write-up: Severe joint aches, fever-type symptoms, nausea


Changed on 5/7/2021

VAERS ID: 919665 Before After
VAERS Form:2
Age:28.0
Sex:Female
Location:New Jersey
Vaccinated:2020-12-29
Onset:2020-12-29
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Arthralgia, Chest X-ray, Nausea, Pyrexia, Blood test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synthroid Claritin Dexilent Terbinafine Vitamin D & B12
Current Illness:
Preexisting Conditions: Hypothyroid GERD
Allergies: Bactrim Bactrim
Diagnostic Lab Data: Blood work 12/30/20 Chest X-ray 12/30/20
CDC 'Split Type':

Write-up: Severe joint aches, fever-type symptoms, nausea


Changed on 5/14/2021

VAERS ID: 919665 Before After
VAERS Form:2
Age:28.0
Sex:Female
Location:New Jersey
Vaccinated:2020-12-29
Onset:2020-12-29
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Arthralgia, Chest X-ray, Nausea, Pyrexia, Blood test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synthroid Claritin Dexilent Terbinafine Vitamin D & B12
Current Illness:
Preexisting Conditions: Hypothyroid GERD
Allergies: Bactrim Bactrim
Diagnostic Lab Data: Blood work 12/30/20 Chest X-ray 12/30/20
CDC 'Split Type':

Write-up: Severe joint aches, fever-type symptoms, nausea

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