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This is VAERS ID 927096

History of Changes from the VAERS Wayback Machine

First Appeared on 1/15/2021

VAERS ID: 927096
VAERS Form:2
Age:60.0
Sex:Male
Location:Massachusetts
Vaccinated:2020-12-28
Onset:2020-12-29
Submitted:0000-00-00
Entered:2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest X-ray, Chills, Echocardiogram, Fatigue, Flushing, Generalised tonic-clonic seizure, Hyperhidrosis, Myalgia, Pulmonary embolism, Pyrexia, Ultrasound abdomen, Computerised tomogram abdomen, Computerised tomogram head, Computerised tomogram thorax abnormal, Scan with contrast, Blood test, Legionella test, Streptococcus test, Magnetic resonance imaging brain, SARS-CoV-2 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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Venlafaxine 150mg daily Ibuprofen 600mg 2x/week
Current Illness: None
Preexisting Conditions: Mild osteoarthritis
Allergies: N/A
Diagnostic Lab Data: CT head without contrast Blood work CT abdomen/pelvis with contrast Xray chest Covid-19 RT-PCR Legionella and Strep Urine Echo TTE MRI brain with and without contrast MRA head without contrast US abdomen CT chest Pulmonary embolism with contrast
CDC 'Split Type':

Write-up: Day 2 (12/29/20): Fever (<100 degrees), Mild muscle aches, Fatigue Day 3 (12/30/20): Fatigue, Muscle aches Day 4 (12/31/20): Alternating chills and profuse sweating starting at 8am, Full body flushing, Grand Mal Seizure at 4:30pm


Changed on 5/7/2021

VAERS ID: 927096 Before After
VAERS Form:2
Age:60.0
Sex:Male
Location:Massachusetts
Vaccinated:2020-12-28
Onset:2020-12-29
Submitted:0000-00-00
Entered:2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest X-ray, Chills, Echocardiogram, Fatigue, Flushing, Generalised tonic-clonic seizure, Hyperhidrosis, Myalgia, Pulmonary embolism, Pyrexia, Ultrasound abdomen, Computerised tomogram abdomen, Computerised tomogram head, Computerised tomogram thorax abnormal, Scan with contrast, Blood test, Legionella test, Streptococcus test, Magnetic resonance imaging brain, SARS-CoV-2 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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Venlafaxine 150mg daily Ibuprofen 600mg 2x/week
Current Illness: None
Preexisting Conditions: Mild osteoarthritis
Allergies: N/A N/A
Diagnostic Lab Data: CT head without contrast Blood work CT abdomen/pelvis with contrast Xray chest Covid-19 RT-PCR Legionella and Strep Urine Echo TTE MRI brain with and without contrast MRA head without contrast US abdomen CT chest Pulmonary embolism with contrast
CDC 'Split Type':

Write-up: Day 2 (12/29/20): Fever (<100 degrees), Mild muscle aches, Fatigue Day 3 (12/30/20): Fatigue, Muscle aches Day 4 (12/31/20): Alternating chills and profuse sweating starting at 8am, Full body flushing, Grand Mal Seizure at 4:30pm


Changed on 5/14/2021

VAERS ID: 927096 Before After
VAERS Form:2
Age:60.0
Sex:Male
Location:Massachusetts
Vaccinated:2020-12-28
Onset:2020-12-29
Submitted:0000-00-00
Entered:2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest X-ray, Chills, Echocardiogram, Fatigue, Flushing, Generalised tonic-clonic seizure, Hyperhidrosis, Myalgia, Pulmonary embolism, Pyrexia, Ultrasound abdomen, Computerised tomogram abdomen, Computerised tomogram head, Computerised tomogram thorax abnormal, Scan with contrast, Blood test, Legionella test, Streptococcus test, Magnetic resonance imaging brain, SARS-CoV-2 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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Venlafaxine 150mg daily Ibuprofen 600mg 2x/week
Current Illness: None
Preexisting Conditions: Mild osteoarthritis
Allergies: N/A N/A
Diagnostic Lab Data: CT head without contrast Blood work CT abdomen/pelvis with contrast Xray chest Covid-19 RT-PCR Legionella and Strep Urine Echo TTE MRI brain with and without contrast MRA head without contrast US abdomen CT chest Pulmonary embolism with contrast
CDC 'Split Type':

Write-up: Day 2 (12/29/20): Fever (<100 degrees), Mild muscle aches, Fatigue Day 3 (12/30/20): Fatigue, Muscle aches Day 4 (12/31/20): Alternating chills and profuse sweating starting at 8am, Full body flushing, Grand Mal Seizure at 4:30pm

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