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This is VAERS ID 1437232

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1437232
VAERS Form:2
Age:20.0
Sex:Male
Location:California
Vaccinated:2021-06-29
Onset:2021-06-29
Submitted:0000-00-00
Entered:2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Flushing, Hyperhidrosis, Seizure

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Severe, Systemic: Seizure-Medium, Additional Details: Pt had a seizure about 3 minutes after receiving the second Moderna vaccine. He previously reported to adverseve reaction with 1st vaccine. Per mom who is a RN, pt first stated that he was lightheaded and she had him sit down. Then his eyes rolled back and he had a seizure. Mom shouted to me that he was having a reaction and she called 911 from her cell phone. A few minutes later he was able to talk to his as we waited for the paramedics.

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