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This is VAERS ID 1467762

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1467762
VAERS Form:2
Age:34.0
Sex:Male
Location:Pennsylvania
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 052C21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Electrocardiogram, Fall, Head injury, Syncope

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 that we were made aware of.
Current Illness: None reported.
Preexisting Conditions: None reported. He stated after the incident that he has fainted in the past when getting bloodwork done and during a tattoo, but only stated this after the incident.
Allergies: No allergies he is aware of.
Diagnostic Lab Data: EMT''s checked his blood pressure and heart rate and did an EKG. (07/13/21)
CDC 'Split Type':

Write-up: Patient fainted while sitting in a chair in our waiting area. He slowly fell forward, lightly hit his head of the blood pressure machine, and went to the ground. He was out for only 5-10 seconds and able to speak with me right after waking up. We called 911, he stated he felt light headed until the EMT''s arrived and they did an EKG and blood pressure/heart rate reading and decided to take him to the hospital just to be safe.

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