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This is VAERS ID 1376042

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1376042
VAERS Form:2
Age:20.0
Sex:Male
Location:Texas
Vaccinated:2021-06-03
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Dyspnoea, Gait disturbance, Headache, Mental impairment, Impaired driving ability, Impaired work ability

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: Unknown
Current Illness: None
Preexisting Conditions: History of Hypertension
Allergies: Morphine and Tramadol
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: 6/4/2021 1730 Pt called and stated that he felt fine the day of the 2nd Moderna vaccine, but when he woke up early the next morning, he experienced dizziness and his gait was unsteady. He went to work and began to feel worse. His co-workers noticed that he was not completing his paperwork correctly and he struggled doing his daily tasks. He stated he felt like he was going to pass out and was out of breath. His supervisor sent him home. He attempted to drive home and swerved off the road. He parked his car and got a ride home. He slept for several hours. He stated he is feeling better this evening. Now he has a headache, but does not have dizziness, unsteady gait, or feeling like he will pass out. I advised him that headache is a possible side effect of the vaccine, but the other symptoms are uncommon. I asked him to seek medical attention if the symptoms come back. He voiced understanding.

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