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This is VAERS ID 1467218

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1467218
VAERS Form:2
Age:65.0
Sex:Male
Location:Arkansas
Vaccinated:2021-07-13
Onset:2021-07-13
Submitted:0000-00-00
Entered:2021-07-13
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
Died? No
Permanent Disability? No
Recovered? No
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: 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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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1467218&WAYBACKHISTORY=ON


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