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This is VAERS ID 1474996

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1474996
VAERS Form:2
Age:21.0
Sex:Male
Location:California
Vaccinated:2021-07-15
Onset:2021-07-15
Submitted:0000-00-00
Entered:2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Dyschromatopsia, Hypoacusis, Laboratory test

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
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: About 5 minutes after giving the patient the shot, patient started feeling very dizzy, when asked if he would like an ambulance he refused. After a few more minutes, patient said he was feeling a little better. No trouble breathing or talking. After a few more minutes patient started holding his ear and said he was having trouble hearing and started seeing colors. We asked if patient would like an ambulance and patient agreed. Paramedics came and did some tests.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1474996&WAYBACKHISTORY=ON


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