VAERS ID: 1753039

AGE: 70| SEX: F|STATE: NY (United States)

Description

Headache, tired, achy, chills, nausea, felt like vomiting, loss of appetite, arm pain and temperature increased to 99.7

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Symptoms

Chills, Headache, Nausea, Pain, Body temperature increased, Fatigue, Pain in extremity, Decreased appetite

Vaccines

VAX DATE: 02-16-2021| ONSET DATE: 02-16-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 2 COVID19 MODERNA SYR LA

RECVDATE:10-01-2021
RPT_DATE:
CAGE_YR:70
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:none
V_ADMINBY:PVT
OTHER_MEDS:Metoprolol, Hydrochlorothiazide, Vitamin D3, Tylenol
CUR_ILL:High Blood Pressure
HISTORY:High Bloood Pressure
PRIOR_VAX:Dizzy right after Shingles vaccine
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:10-01-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:Codeine, Thimerosal, Lisinopril, Nickel
V_FUNDBY:

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