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This is VAERS ID 1366338

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1366338
VAERS Form:2
Age:26.0
Sex:Male
Location:California
Vaccinated:2021-06-01
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 - / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Feeling abnormal, Loss of consciousness

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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Patient just got the shot and immediately feel a weird sensation. He sat on the chair to be observed and passed out almost immediately. We rushed to him and called out for him. He opened his eyes and slowly told us that he thinks he fainted. I helped him elevated both legs on the chair and talked to him if he''s hurt or any other weird feeling. He told me he''s feeling fine again. I have him lay down with his legs elevated for another 5 minutes and helped him sit up. He was able to get up by himself and sat back on the chair. A couple minutes later, I took his blood pressure and it was 129/85 and pulse was 61.

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