VAERS ID: 2265779

AGE: 48| SEX: F|State: WI

Description

Site: Bruising at Injection Site-Severe, Site: Pain at Injection Site-Severe, Site: Redness at Injection Site-Severe, Systemic: Nausea-Severe

Symptoms

Injection site bruising, Injection site erythema, Injection site pain, Nausea

Vaccines

VAX DATE: 28 April 2022 | ONSET DATE: 28 April 2022 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • MODERNA
  • COVID19 (COVID19 (MODERNA))

        RECVDATE:
        05 May 2022
        CAGE_YR:
        48
        CAGE_MO:
        RPT_DATE:
        DIED:
        DATEDIED:
        L_THREAT:
        ER_VISIT:
        HOSPITAL:
        HOSPDAYS:
        X_STAY:
        DISABLE:
        RECOVD:
        Y
        LAB_DATA:
        V_ADMINBY:
        PHM
        OTHER_MEDS:
        CUR_ILL:
        HISTORY:
        PRIOR_VAX:
        SPLTTYPE:
        FORM_VERS:
        2
        TODAYS_DATE:
        05 May 2022
        BIRTH_DEFECT:
        OFC_VISIT:
        Y
        ER_ED_VISIT:
        ALLERGIES:
        V_FUNDBY: