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This is VAERS ID 1371550

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371550
VAERS Form:2
Age:30.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-06-03
Onset:2021-06-03
Submitted:0000-00-00
Entered:2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Pallor, Syncope

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? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none stated
Preexisting Conditions: none stated
Allergies: none stated
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fainted and looked pale

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1371550&WAYBACKHISTORY=ON


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