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|History of Changes from the VAERS Wayback Machine|
|Vaccination / Manufacturer||Lot / Dose||Site / Route|
|COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA||045C21A / 1||LA / IM|
Administered by: Pharmacy Purchased by: ??
Symptoms: Asthenia, Dizziness, Nausea
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)? Yes
Other Medications: None given
Current Illness: None given
Preexisting Conditions: None given
Allergies: None given
Diagnostic Lab Data: Blood pressure taken 115/78 on 7/13/2021
CDC 'Split Type':
Write-up: Patient became dizzy, weak and woozy/nauseous. He reported that he may have passed out for a quick moment.
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