Adverse Event Reporting

VAERS ID 1936560
Gender Male
Age 75
StateCode CO
Pharmaceutical Company MODERNA
Lot Number 939904
Number of vaccinations 3
Vaccinated 2021-11-03
Onset 2021-11-03
Condition Recovered
  • Pyrexia
  • Headache
  • Parosmia
  • Chills
  • Myalgia
  • Feeling cold

Current Illness


Preexisting Conditions

Chronic lymphocytic leukemia, nonspecific interstitial pneumonitis, sleep apnea, irritable bowel syndrome, chronic constipation, esophageal reflux, hypogammaglobulinemia, arthritis, BPH (benign prostatic hyperplasia), degeneration of lumbar or lumbosacral intervertebral disc, allergic rhinitis

Other Medications

bupropion, cetirizine, famotidine, finasteride, fish oil, fluticasone propionate, immune globulin, kristalose, linaclotide, multivitamins with minerals, pramipexole, tamulosiin, venlafaxine

Previous Vaccinations


penicillin, cephalexin, Pepcid AC and other protein pump inhibitors pollen, animal dander,

Laboratory Data



fever 100- 102, shivering during night and couldn't get warm, very bad headache, very sore muscles throughout body, one hours episode of phantosmia (fourth one in three years) four hours after fever broke, 38 hours of reaction