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This is VAERS ID 1152127

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1152127
VAERS Form:2
Age:15.0
Sex:Female
Location:Minnesota
Vaccinated:2021-03-26
Onset:2021-03-26
Submitted:0000-00-00
Entered:2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003821A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest discomfort, Chest pain, Dyspnoea, Presyncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness: Patient had not eaten and had only a small amount of fluids prior to receiving the vaccination
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pre-syncope. Chest tightness/short of breath. Sternal Chest pain. Symptoms started 30 minutes after vaccination. Serial vitals and exam x 2 were normal. Symptoms resolved after another 60 minutes of observation.

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