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This is VAERS ID 1330916

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1330916
VAERS Form:2
Age:75.0
Sex:Female
Location:California
Vaccinated:2021-05-19
Onset:2021-05-19
Submitted:0000-00-00
Entered:2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Dyspnoea, Nausea

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)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: none
Preexisting Conditions: asthma, diabetes, high cholesterol, high blood pressure
Allergies: cephalexin, amoxicillin
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: patient experienced shortness of breath about 2 minutes after giving the shot. pt also later (in maybe 10 minutes) became nauseated and dizzy

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