National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1376028

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1376028
VAERS Form:2
Age:48.0
Sex:Male
Location:California
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 044B21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chest discomfort, Hypoaesthesia, Presyncope

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: MMR
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: self reported seizure to first dose of MMR vaccine at 1 years old
Diagnostic Lab Data: BP of 151/97 and HR 94
CDC 'Split Type':

Write-up: patient started feeling numbness in their finger, toes, arms, and legs followed by chest pressure and near syncopal episode. Blood pressure was taken and was 151/97 with a heart rate of 94. Ambulance arrived, took vitals at pharmacy, after which patient was taken to the nearby hospital.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1376028&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166