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This is VAERS ID 1327509

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1327509
VAERS Form:2
Age:41.0
Sex:Male
Location:California
Vaccinated:2021-05-04
Onset:2021-05-04
Submitted:0000-00-00
Entered:2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Blood magnesium, Blood thyroid stimulating hormone, Chest X-ray, Dizziness, Electrocardiogram, Full blood count, Glycosylated haemoglobin, Headache, Hypertension, International normalised ratio, Lipids, Prothrombin time, Urine analysis, Thyroxine free, Cardiac function test, Troponin, Metabolic function test, Influenza virus test, SARS-CoV-2 test

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)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Ibuprofen, PCN class
Diagnostic Lab Data: Lipid panel, UA, FLu and COVID swabs, CMP, PT/INR, CBC w/diff, Mg, A1C, T4 Free, Troponin, TSH, CXR, EKG, Cardian Panel
CDC 'Split Type':

Write-up: member complained of dizziness and headache after vaccine administration. Patient brought to lay down on a gurney. Headache resolved after patient in supine position. Vitals stable with noted hypertension: 194/129 that remained elevated for 30 minutes. Dizziness and headache resolved. Dr encouraged member ED assessment of continued hypertension. Member agreed to have wife (at bedside) drive him immediately to the ED. Per EMR, member went to emergency and was admitted 5/4- 5/6/2021 and placed on antihypertensives and hypothyroid meds.

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