National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1437234

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1437234
VAERS Form:2
Age:54.0
Sex:Male
Location:Wisconsin
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 011D21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Asthenia, Confusional state, Dizziness, Dyspnoea, Fatigue, Flushing, Hyperhidrosis, Hypotension, Lethargy, Syncope, Tremor, Visual impairment

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: Allergic: Difficulty Breathing-Medium, Systemic: Confusion-Severe, Systemic: Dizziness Lightheadedness-Severe, Systemic: Exhaustion/Lethargy-Severe, Systemic: Fainting/Unresponsive-Severe, Systemic: Flushed/Sweating-Severe, Systemic: Hypotension-Severe, Systemic: Shakiness-Mild, Systemic: Visual Changes/Disturbances-Severe, Systemic: Weakness-Severe. Additional Details: ER determined patient had a vasovagal syncope episode. At the time of the reaction, patient appeared to have trouble breathing (head back and making noises). I could not find a strong carotid pulse, so 1 dose of epinephrine was given.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1437234&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166