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This is VAERS ID 930235

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 930235
VAERS Form:2
Age:44.0
Sex:Male
Location:Colorado
Vaccinated:2020-12-30
Onset:2021-01-02
Submitted:0000-00-00
Entered:2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain, Asthenia, Back pain, Muscular weakness, Paraesthesia, Reflexes abnormal, Computerised tomogram spine

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)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multivitamin daily Ambien 5mg daily/nighttime
Current Illness:
Preexisting Conditions: History of Bells Palsy
Allergies:
Diagnostic Lab Data: CT L-Spine *NSMC 01/02
CDC 'Split Type':

Write-up: Hospital on 1/2 - then again on 1/5, transferred and admitted to hospital, discharged 1/6 Abnormal reflex/weakness back pain paresthesia and weakness of legs abdominal pain evaluation for possible GBS post covid 19 vaccine


Changed on 5/7/2021

VAERS ID: 930235 Before After
VAERS Form:2
Age:44.0
Sex:Male
Location:Colorado
Vaccinated:2020-12-30
Onset:2021-01-02
Submitted:0000-00-00
Entered:2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain, Asthenia, Back pain, Muscular weakness, Paraesthesia, Reflexes abnormal, Computerised tomogram spine

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)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multivitamin daily Ambien 5mg daily/nighttime
Current Illness:
Preexisting Conditions: History of Bells Palsy
Allergies:
Diagnostic Lab Data: CT L-Spine *NSMC 01/02
CDC 'Split Type':

Write-up: Hospital on 1/2 - then again on 1/5, transferred and admitted to hospital, discharged 1/6 Abnormal reflex/weakness back pain paresthesia and weakness of legs abdominal pain evaluation for possible GBS post covid 19 vaccine


Changed on 5/21/2021

VAERS ID: 930235 Before After
VAERS Form:2
Age:44.0
Sex:Male
Location:Colorado
Vaccinated:2020-12-30
Onset:2021-01-02
Submitted:0000-00-00
Entered:2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain, Asthenia, Back pain, Muscular weakness, Paraesthesia, Reflexes abnormal, Computerised tomogram spine

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)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multivitamin daily Ambien 5mg daily/nighttime
Current Illness:
Preexisting Conditions: History of Bells Palsy
Allergies:
Diagnostic Lab Data: CT L-Spine *NSMC 01/02
CDC 'Split Type':

Write-up: Hospital on 1/2 - then again on 1/5, transferred and admitted to hospital, discharged 1/6 Abnormal reflex/weakness back pain paresthesia and weakness of legs abdominal pain evaluation for possible GBS post covid 19 vaccine

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