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This is VAERS ID 1329857

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1329857
VAERS Form:2
Age:25.0
Sex:Female
Location:New York
Vaccinated:2021-05-18
Onset:2021-05-18
Submitted:0000-00-00
Entered:2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dyspnoea, Syncope, Unresponsive to stimuli, Fear of injection

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: Allergic: Difficulty Breathing-Mild, Systemic: Fainting / Unresponsive-Severe, Additional Details: Patient stated was nervous around needles, but never fainted from a vaccine. Patient fainted twice in administration room, but recovered well afterwards. Patient stated difficulty breathing, but did not need an epipen as airway was not blocked. Water was given, she recovered well, and patient rested outside pharmacy for almost 1 hour. Patient left with no issues.

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