Your Health. Your Family. Your Choice.
|History of Changes from the VAERS Wayback Machine|
|Vaccination / Manufacturer||Lot / Dose||Site / Route|
|COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA||036B21A / 1||LA / IM|
Administered by: Public Purchased by: ??
Symptoms: Vision blurred
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Other Medications: Patients states he takes no medications.
Current Illness: none
Preexisting Conditions: Keratoconus
Diagnostic Lab Data: Patient has yet to seek treatment, but has been advised to seek emergency treatment immediately.
CDC 'Split Type':
Write-up: Patient received first dose of Moderna COVID-19 vaccine on 7/15/21 at approximately 0900 by this RN. Patient reported NKA or conditions that may contraindicate receiving vaccine. After vaccine administration, patient was observed by this RN for fifteen minutes. Prior to leaving patient stated he felt fine and appeared to be in no apparent distress upon departure. At approximately 15:30, patient called stating he had been experiencing blurred vision since approximately "10:30 or 11:00 that morning" and wonders if he should seek medical attention. This RN encouraged patient to seek immediate medical attention. Patient reports a chronic medical condition called Keratoconus. Patient denies any other medical problems or allergies. Patient states he will seek immediate medical attention at the local ER or an urgent care. Patient encouraged to call back if needed by this RN.
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