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This is VAERS ID 1436993

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1436993
VAERS Form:2
Age:29.0
Sex:Female
Location:Illinois
Vaccinated:2021-06-26
Onset:2021-06-26
Submitted:0000-00-00
Entered:2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0574C21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chills, Dizziness, Fall, Feeling hot, Flushing, Hyperhidrosis, Nausea, Syncope, Unresponsive to stimuli

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Systemic: Chills-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Nausea-Medium, Additional Details: Pt reported feeling "queasy", "hot", having "chills" and "sweating", pt fainted and fell out of chair. Was responsive after fainting and reports no pain, no trouble breathing. Assessed by NP from clinic, BP and HR normal. EMS was called and pt was transferred to their care for follow up. Contacted patient around 3pm same day and pt spouse reported pt feeling much better and was "doing ok"

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