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This is VAERS ID 1467746

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1467746
VAERS Form:2
Age:18.0
Sex:Female
Location:Kentucky
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 016C21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Hypotonia, Loss of consciousness, Muscular weakness, Unresponsive to stimuli, Eye movement disorder

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)? No
Hospitalized? No
Previous Vaccinations: Patient has passed out with every vaccine and blood draw
Other Medications: Not available
Current Illness: Not available
Preexisting Conditions: Anemia (past condition)
Allergies: Penicillin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Immediately after receiving the injection, the patient passed out. She was already in the proper sitting position, and I ( immunizer) saw that she was passing out. I had just placed the syringe in the sharps container and was about to place her bandage on, when her head went slack and I saw her eyes roll. I immediately leaned one arm over her to keep her from falling out of the chair, while using my other hand to steady her neck and head. The patients mother was in the room with us, and was talking to her daughter, trying to revive her. I informed the patients mother that I would be unable to leave her daughter, and gave her the name of my pharmacist on duty and asked her to step out and go to the consult window and have him come back to the immunization room. Pharmacist and the patients mother returned in short order and pharmacist verified what I had already checked that she was showing signs of breathing, chest was rising and falling. He helped support her head and asked the mother to gently rub her face to try to wake the patient back up. He stepped out briefly while I was continuing to support the patient and came back with some wet paper towels to place on the back of the patients neck and forehead. After approx. 10 minutes the patient came to and was able to stand and walk under her own power. She sat in the waiting room for an additional 15 minutes before leaving.

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