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This is VAERS ID 1375944

History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1375944
VAERS Form:2
Age:18.0
Sex:Female
Location:Puerto Rico
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood glucose normal, Dizziness, Nausea, Tremor

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient has no record with us, but patient mentioned that he suffers from thyroid.
Current Illness: None
Preexisting Conditions: None
Allergies: It is not allergic.
Diagnostic Lab Data: The doctor informed her that the reaction he had was due to the fright he had.
CDC 'Split Type':

Write-up: Patient arrives very nervous to get the vaccine, she was very scared. She was given the vaccine at 3:10PM and at 5 minutes (3:15PM) she begins to complain that she is dizzy, then says she feels nauseous and begins to shake. I proceed to take his blood pressure and he had 128/89 and a pulse at 126. He called 911 and when they arrived they checked his blood pressure and sugar levels and everything came out normal. Paramedics took her to the hospital. At 6:00PM, an Medical Staff came to inform us that she had contacted the patient and she informed her that she was fine and that the doctor told her that it was the fright that caused the reaction.

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