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This is VAERS ID 1434917

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1434917
VAERS Form:2
Age:24.0
Sex:Male
Location:California
Vaccinated:2021-06-26
Onset:2021-06-26
Submitted:0000-00-00
Entered:2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Fall, Balance disorder, Tachyphrenia

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: dizziness after receiving any vaccine throughout his whole life
Other Medications: Patient denies taking prescription, over-the-counter medications, dietary supplements, or herbal remedies at the time of vaccination.
Current Illness: Patient denies having other illnesses at the time of vaccination and up to one month prior.
Preexisting Conditions: Patient denies having any chronic or long-standing health conditions.
Allergies: Patient reports to have no known allergies to food, medication, or other products.
Diagnostic Lab Data: Supervisor on duty asked the patient if he would like to be taken to the hospital emergency department, but patient stated he did not need to go and said he felt fine.
CDC 'Split Type':

Write-up: After receiving the Moderna vaccine, the patient was sitting in a chair in the pharmacy waiting area. About 5 minutes afterwards, he fell out of his chair. Upon asking the patient if he was okay and what happened, he reported he felt dizzy with racing thoughts on his mind. Then he lost his balance, slipped out of his chair, and fell to the floor. He stated he has dizziness after every vaccine he has received in the past. He sat back in the chair and rested, and also reported he felt better. The supervisor on duty provided the patient with water. About 15 minutes after falling, the patient stated he felt fine and wanted to leave. He was stable upon standing up from the chair. I informed him if he experiences any other symptoms, that he should call my pharmacy, or if he experiences anaphylaxis, he should call 911 and seek immediate medical attention.

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