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VAERS ID: | 911587 |
VAERS Form: | 2 |
Age: | 42.0 |
Sex: | Male |
Location: | Wisconsin |
Vaccinated: | 2020-12-26 |
Onset: | 2020-12-26 |
Submitted: | 0000-00-00 |
Entered: | 2020-12-29 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 0011JOA / 1 | LA / IM |
Administered by: Private Purchased by: ??
Symptoms: Anxiety, Aphasia, Back pain, Bruxism, Chills, Cold sweat, Dyspnoea, Fatigue, Feeling drunk, Memory impairment, Myalgia, Nausea, Paranoia, Thinking abnormal, Vomiting, Muscle tightness, Bradyphrenia
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril Entyvio vit B12 vit D Tylenol
Current Illness:
Preexisting Conditions: Ulcerative Colitis Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: 5 to 10 minutes after receiving vaccine started feeling "drunk", anxious, paranoid. Muscles became mildly tense and teeth clenched. The physical aspects only lasted a short time (10-15 minutes)the anxiousness paranoia and "drunk" feeling lasted approximately another hour. An hour after receiving vaccine started experiencing nausea and vomiting with extreme muscle soreness that was generalized and fatigue. After napping the nausea and vomiting resolved. Woke up shivering in cold sweats and shivering. Began experiencing forgetfulness and having problems thinking correctly. Issues with finding words, conversing and conveying information to other people. Shortly after waking up began experiencing severe back pain in lower to mid left back. Pain was shooting and it did not seem to matter on positioning. Back pain has resolved. Day 2 still experiencing severe fatigue, extreme muscle soreness, forgetfulness and not thinking correctly. Having issues finding words to use and communicate. Thinking process seems slow. Occasional cold sweats and shivering. Day 3 still feeling of forgetfulness, unable to find words and communicate correctly, slow thinking process, occasional cold sweats and shivering, occasional bouts of anxiety (lasts only 2-3 minutes at a time), short bouts of shortness of breath with exertion resolved quickly. Some muscle soreness seems to be resolving.
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