Vaer Report Details
Age: 46 years old
Gender: Female
State: Indiana
- Patient Died?
- No
- Vaccine information
-
Name: COVID19 (COVID19 (MODERNA))
Type: Coronavirus 2019 vaccine
Manufacturer: MODERNA
Lot: 025l21b
- Date report was received
- 2022-03-04
- Date form completed
- Date Vaccinated
- 2022-02-07
- Date of Onset
- 0
- Number of days (onset date – vaccination date)
- 0
- Adverse Event Description
-
site: pain at injection site-mild, additional details: patient called pharmcay to reschedule her 3/7/22 appointment. she also complained to rph that she stlll has soreness at the injection site of her fiest covid vaccination. she calaimed no infection was evident when questioned. rph advised she visit to her priamry care provider to be diagnoised. now answer when same rph called back to check on her the following day
- Lab Data
-
na
- List of symptoms
-
injection site pain
- Patient Died?
- No
- Date Died
- NA
- Birth defect
- false
- Vaccine Administered By:
- Pharmacy or store
- Vaccine Purchased By:
- Unknown
- Patient visit ER?
- No
- Patient Hospitalized?
- No
- Stay in hospital
- No
- Days in hospital
- Unspecified
- Permanent disability?
- No
- Allergies:
-
na
- Current Illness
-
na