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This is VAERS ID 1418167

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1418167
VAERS Form:2
Age:22.0
Sex:Male
Location:Utah
Vaccinated:2021-06-19
Onset:2021-06-20
Submitted:0000-00-00
Entered:2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Blindness transient, Chest pain, Computerised tomogram, Loss of consciousness, Myocarditis, Blood test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: CT scan Blood tests
CDC 'Split Type':

Write-up: Passed out, vision blacked out, severe chest pains, inflammation around heart

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1418167&WAYBACKHISTORY=ON


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