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This is VAERS ID 1377799

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1377799
VAERS Form:2
Age:28.0
Sex:Male
Location:California
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Blood pressure decreased, Malaise, Pallor, Presyncope

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 provided by patient
Preexisting Conditions: No
Allergies: NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: About 5 minutes into his post-vaccination observation, patient felt unwell and tried to get up to get help. We are on-site pharmacy located inside the Health Center. At the time, a nurse is monitoring patients at the observation area. He noticed the patient was pale and he reached over to grab the patient as he was about to fall/faint. The nurse took him back into one of the patient''s room. His blood pressure was very low. Patient was given 2 boxes of apple juices and some Gatorade. He rested for another 30 minutes and he felt better. Then he left.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1377799&WAYBACKHISTORY=ON

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