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This is VAERS ID 1367836

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1367836
VAERS Form:2
Age:19.0
Sex:Female
Location:Virginia
Vaccinated:2021-06-02
Onset:2021-06-02
Submitted:0000-00-00
Entered:2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dizziness, Seizure

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? No
Previous Vaccinations:
Other Medications: Zoloft, Olanzapine, Aurovela
Current Illness:
Preexisting Conditions: Functional Neurologic Disorder, Pseudoseizures
Allergies: Amoxacillin- hives
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Seizure activity noted within 30 minutes of vaccination. Pt known to have functional neurologic disorder and pseudoseizures daily (sometimes back-to-back). Pt alert and orientedx4. Pt dizzy and states she did not eat lunch today. Provided with water and granola bar. Second seizure noted 20 minutes later. Pt stayed for observation for additinal 40 minutes following second seizure. Client refused transportation to hospital and clients brother came to pick her up.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1367836&WAYBACKHISTORY=ON


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