VAERS ID: 1884707

AGE: 66| SEX: F|STATE: CT (United States)

Description

Site: Pain at Injection Site-Mild, Systemic: pain under breast-Medium, Additional Details: Patient complained about having pain under breast after third dose of moderna. Patients reports that the pain goes to the back area but more in the front. patient is currently consulting with doctor. Patient will be getting a X-ray and PET to investigate further.

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Symptoms

Injection site pain, Back pain, Non-cardiac chest pain

Vaccines

VAX DATE: 09-22-2021| ONSET DATE: 09-22-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 3 COVID19 MODERNA 050E IM LA

RECVDATE:11-19-2021
RPT_DATE:
CAGE_YR:66
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:PHM
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:11-19-2021
BIRTH_DEFECT:U
OFC_VISIT:Y
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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