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This is VAERS ID 1371746

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371746
VAERS Form:2
Age:34.0
Sex:Male
Location:Georgia
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 049C21A / 2 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Loss of consciousness, Sensory disturbance

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: Patient was fine at time of injection. Patient stated he started feeling the vaccine throughout his body and that he was going to pass out. Patient passed out and came back to quickly; patient drank a bottle of water once he came to. I had the patient wait for 30 minutes in the pharmacy; he was fine at the time he left. Called back at 3:11pm; he states he is doing fine. He passed out with the first vaccination as well.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1371746&WAYBACKHISTORY=ON


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