| VAERS ID: |
912883 (history) |
| Form: |
Version 2.0 |
| Age: |
41.0 |
| Sex: |
Male |
| Location: |
Missouri |
| Vaccinated: | 2020-12-01 |
| Onset: | 2020-12-23 |
| Days after vaccination: | 22 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-29 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / 1 |
LA / SYR |
Administered by: Private Purchased by: ?
Symptoms: Dyspnoea,
Joint stiffness
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: -Seroquel 1-300 mg -Gabapentin 2-300 mg -Depakote 3-250 mg -Escitalopram (Lexapro) 10 mg -Copaxone 1-40 mg MWF Vitamin B6 1-100 mg Vitamin D3 3-1000 IU
Current Illness:
Preexisting Conditions: Multiple Sclerosis, Bipolar
Allergies: Zyprexa, Trazadone
Diagnostic Lab Data:
CDC Split Type:
Write-up: Difficulty catching my breath, stiff joints in legs |
