Adverse Event Reporting

VAERS ID 911854
Gender Female
Age 70
StateCode CT
Pharmaceutical Company MODERNA
Lot Number 011J20A
Number of vaccinations 1
Vaccinated 2020-12-23
Onset 2020-12-24
Condition Permanent Disability
  • Pain in extremity
  • Pain
  • Back pain
  • Neck pain

Current Illness

High blood pressure, cholestrol

Preexisting Conditions

high blood pressure, cholesterol, obesity

Other Medications

Losarten, pravastan, B-12

Previous Vaccinations


allergy to pineapple skin

Laboratory Data



I received the vaccine shot on 12/23/20 at 3 pm.
By 12/24/20, I had pain in my left arm that radiated to my neck and back on the left side.
Over the past 4/5 days, I continue to have pain in my left arm, back and neck