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This is VAERS ID 1469949

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1469949
VAERS Form:2
Age:20.0
Sex:Male
Location:Minnesota
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 011D21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Asthenia, Confusional state, Dizziness, Flushing, Hyperhidrosis, Nausea, Syncope, Tremor, Unresponsive to stimuli, Vomiting

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: Confusion-Mild, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Nausea-Severe, Systemic: Shakiness-Severe, Systemic: Vomiting-Severe, Systemic: Weakness-Severe, Additional Details: Patient approached pharmacy and appeared normal/healthy. Vaccine was mixed/prepared/given proper protocol. Patient sat down after vaccination and within 5-10 minutes he fainted face forward from a seated position. He regained consciousness within 30 seconds of fainting. He then vomited within minutes after he sat up after fainting. A nurse practitioner was in store shopping and stopped by to read his blood pressure (135/76) then the EMT arrived within a minute of the blood pressure reading.

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