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This is VAERS ID 1378183

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1378183
VAERS Form:2
Age:50.0
Sex:Female
Location:Unknown
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 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
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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
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.

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