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This is VAERS ID 1479064

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1479064
VAERS Form:2
Age:35.0
Sex:Female
Location:Ohio
Vaccinated:2021-07-03
Onset:2021-07-03
Submitted:0000-00-00
Entered:2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Disorientation, Loss of consciousness, Eye movement disorder

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamotrigine 200mg, valcyclovir 500mg
Current Illness:
Preexisting Conditions:
Allergies: kna
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient''s eyes rolled back, head fell back and patient passed out. 911 was called. Patient came to approximately 1 min later and felt disoriented. Medics arrived and took her to hospital for evaluation.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1479064&WAYBACKHISTORY=ON


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