VAERS ID: 907867

AGE: 42| SEX: F|STATE: PA (United States)

Description

feeling off, shaky, swollen hand and arm on injection side. slight slurred speech

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Symptoms

Tremor, Dysarthria, Blood test, Feeling abnormal, Arteriogram carotid, Angiogram cerebral, Peripheral swelling

Vaccines

VAX DATE: 12-22-2020| ONSET DATE: 12-22-2020| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 011J20A IM RA

RECVDATE:12-23-2020
RPT_DATE:
CAGE_YR:42
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:in ER at Hospital. CTA of head and neck was completed along with blood work
V_ADMINBY:PVT
OTHER_MEDS:unknown
CUR_ILL:unknown
HISTORY:unknown
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:12-23-2020
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:Y
ALLERGIES:unknown
V_FUNDBY:

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