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This is VAERS ID 956925

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 956925
VAERS Form:2
Age:14.0
Sex:Male
Location:Georgia
Vaccinated:2021-01-13
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Asthma, Chills, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness: none known at time of vaccine.
Preexisting Conditions: Asthma.
Allergies: none
Diagnostic Lab Data: Chest X-ray showed congestion in the lungs.
CDC 'Split Type':

Write-up: The patient received the vaccine and did not have a reaction until Tuesdays the 19th. He had fever and chills. His grandfather signed the consent and told the nurse that he need to have the vaccine because he has asthma. The pediatrician increased his breathing treatment and prescribed antibiotics due to an upper respiratory infect that he had previously. He is now stable and remaining in the home.


Changed on 5/7/2021

VAERS ID: 956925 Before After
VAERS Form:2
Age:14.0
Sex:Male
Location:Georgia
Vaccinated:2021-01-13
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Asthma, Chills, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness: none known at time of vaccine.
Preexisting Conditions: Asthma.
Allergies: none none
Diagnostic Lab Data: Chest X-ray showed congestion in the lungs.
CDC 'Split Type':

Write-up: The patient received the vaccine and did not have a reaction until Tuesdays the 19th. He had fever and chills. His grandfather signed the consent and told the nurse that he need to have the vaccine because he has asthma. The pediatrician increased his breathing treatment and prescribed antibiotics due to an upper respiratory infect that he had previously. He is now stable and remaining in the home.


Changed on 5/14/2021

VAERS ID: 956925 Before After
VAERS Form:2
Age:14.0
Sex:Male
Location:Georgia
Vaccinated:2021-01-13
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Asthma, Chills, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness: none known at time of vaccine.
Preexisting Conditions: Asthma.
Allergies: none none
Diagnostic Lab Data: Chest X-ray showed congestion in the lungs.
CDC 'Split Type':

Write-up: The patient received the vaccine and did not have a reaction until Tuesdays the 19th. He had fever and chills. His grandfather signed the consent and told the nurse that he need to have the vaccine because he has asthma. The pediatrician increased his breathing treatment and prescribed antibiotics due to an upper respiratory infect that he had previously. He is now stable and remaining in the home.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=956925&WAYBACKHISTORY=ON


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