Your Health. Your Family. Your Choice.
|History of Changes from the VAERS Wayback Machine|
|Vaccination / Manufacturer||Lot / Dose||Site / Route|
|COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA||022B21A / 1||LA / IM|
Administered by: Pharmacy Purchased by: ??
Symptoms: Loss of consciousness, Vomiting
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Patient passed out while waiting the 15 minutes wait period after receiving his shot. He later reported that he passes out when nervous. Minutes after while under observation, he also vomited but then felt better and was able to leave with family member after approximately a 30 minute observation period.
Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166