Your Health. Your Family. Your Choice.
|History of Changes from the VAERS Wayback Machine|
|Vaccination / Manufacturer||Lot / Dose||Site / Route|
|COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA||054C21A / 1||RA / IM|
Administered by: Private Purchased by: ??
Symptoms: Blood glucose normal, Electrocardiogram, Syncope, Immediate post-injection reaction
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Diagnostic Lab Data: Pt got transported by EMS to the ER but patient left er without being seen.
CDC 'Split Type':
Write-up: TRIAGE CALLED due to syncopal episode 1:31pm pt got administered 1st Moderna covid vaccine and immediately passed out. RN called triage immediately after at 1:31pm and doctor arrived at seen 1:32 pm. 1:33 pm EKG done NSR, BP 110/90 HR 78 (lowest was 37 HR), temp 98.3, O2 97%, Blood sugar 104. 1:38 pm 911 called Time of EMS arrival and transport pt is awake, alert, oriented. Of note, pt states she usually passes out during vaccinations.
Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166