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This is VAERS ID 1469931

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1469931
VAERS Form:2
Age:21.0
Sex:Female
Location:Tennessee
Vaccinated:2021-07-13
Onset:2021-07-13
Submitted:0000-00-00
Entered:2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Asthenia, Dizziness, Flushing, Hyperhidrosis, Hypotension, Nausea, Syncope, Unresponsive to stimuli

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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Hypotension-Mild, Systemic: Nausea-Mild, Systemic: Weakness-Mild, Additional Details: After administering the immunization, the patient proceeded to the lobby where she sat down. She began to feel nauseous and rose from her seat. She then passed out. I ran out to the lobby and tried to get her to her seat, where she then fainted again. A this time we had a nurse come over and check her blood pressure that was approximately 90/50. After about 5 minutes her blood pressure normalized to approx. 120/80. After 15-30 minutes, her mother picked her up and took her home. No complications

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