VAERS ID: 913009

AGE: 53| SEX: F|STATE: NE (United States)

Description

Patient stated that following her vaccine, she had an intense headache which she described as though she thought she was having an aneurysm. She also experienced body aches, chills, extreme fatigue, muscle soreness & itching. Patient states that she took Norco that she had "laying around" as well as Ibuprofen, Tylenol & tramadol to decrease the intense headache she was experiencing. Per her report, this lasted 3 days however improved slightly each day.

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Symptoms

Chills, Pruritus, Myalgia, Headache, Pain, Fatigue, Mobility decreased

Vaccines

VAX DATE: 12-24-2020| ONSET DATE: 12-24-2020| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 0 COVID19 MODERNA 011J20A IM RA

RECVDATE:12-29-2020
RPT_DATE:
CAGE_YR:53
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:
V_ADMINBY:PVT
OTHER_MEDS:Metformin, gabapentin, HCTZ, aspirin, tramadol - current regular medications took Norco, Tylenol, Tramadol PRN for pain r/t reaction
CUR_ILL:unknown
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:12-29-2020
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:unknown
V_FUNDBY:

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