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This is VAERS ID 1257471

History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 1257471
VAERS Form:2
Age:28.0
Sex:Female
Location:New York
Vaccinated:2021-04-19
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21-2A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Syncope, Unresponsive to stimuli

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: Pt has history of fainting with vaccinations. She fainted immediately following injection and was moved to the floor by her boyfriend. She was fully recovered approximately 20 minutes later.


Changed on 5/14/2021

VAERS ID: 1257471 Before After
VAERS Form:2
Age:28.0
Sex:Female
Location:New York
Vaccinated:2021-04-19
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21-2A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Syncope, Unresponsive to stimuli

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: Pt has history of fainting with vaccinations. She fainted immediately following injection and was moved to the floor by her boyfriend. She was fully recovered approximately 20 minutes later.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1257471&WAYBACKHISTORY=ON


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