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This is VAERS ID 1376318

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1376318
VAERS Form:2
Age:26.0
Sex:Female
Location:Missouri
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Asthenia, Blood pressure decreased, Dizziness, Heart rate increased, Hypotension, Injection site pain, Syncope, Tachycardia, Tremor, Unresponsive to stimuli, Tonic posturing

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: Site: Pain at Injection Site-Mild, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: syncope and tonic presentation for 5-10 seconds, increased pulse and decreased blood pressure-Severe, Systemic: Hypotension-Mild, Systemic: Shakiness-Medium, Systemic: Tachycardia-Mild, Systemic: Weakness-Medium, Additional Details: paramedics called and within 15 minutes patient was able to stand, sit and speak normally and her color had come back. BP and pulse normalized and after 30 minutes of observation by RPh and paramedic was walked out of store by paramedic.

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