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This is VAERS ID 1440603

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1440603
VAERS Form:2
Age:40.0
Sex:Male
Location:Texas
Vaccinated:2021-07-01
Onset:2021-07-01
Submitted:0000-00-00
Entered:2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Feeling abnormal, Feeling hot, Hyperhidrosis, Loss of consciousness, Pallor, Skin warm, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: nausea
Other Medications: Patient states he does not take any medications.
Current Illness: Patient states that he has not been sick in a long time, felt fine today, with no illness today, no fever, nausea, or vomiting in the last month.
Preexisting Conditions: Patient does not have any health conditions that he is aware of.
Allergies: Patient states he has no allergies to any medications, foods, or other products that he knows of.
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Patient received 1st dose of Moderna, then started his 15 minute wait. 11 minutes into the wait period, patient got up and came to the pharmacy counter and said he was feeling real warm and "funny" to the pharmacy technician. The technician alerted the pharmacist and when the pharmacist looked over at the patient, he looked pail and started slouching. Pharmacist ran to patient and caught him as he started to pass out. Pharmacist laid him on the floor and by the time the pharmacist had him laying down, the patient came back awake. Patient was sweaty and very warm to touch. During this process, EMS was called. When they arrived patient was already back to normal cognition and said he felt fine other than being warm. EMS check stats and cleared him to drive home after another 15 minutes wait period. The pharmacist believes this was a vasovagal syncope reaction to this patient getting the Moderna vaccine. Patient was fully recovered within 30 minutes of the adverse reaction.

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