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This is VAERS ID 1484269

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1484269
VAERS Form:2
Age:30.0
Sex:Female
Location:Arkansas
Vaccinated:2021-07-18
Onset:2021-07-18
Submitted:0000-00-00
Entered:2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Anxiety, Dizziness, Dyspnoea, Hyperventilation, Injection site pain, Nervousness

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: Allergic: Difficulty Breathing-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Pt was experiencing a severe anixety attack-Mild, Systemic: Hyperventilation-Mild, Additional Details: Pt was apprehesive about the shot upon arrival to pharmacy. Very nervous. Administer the vaccine and within a few minutes patient begin to complain of lightheadness/breathing issues. I called 911 upon patient request and emts arrived within a matter of minutes. They walked patient to ambulance to check her out. Patient returned to the pharmacy after about 30 minutes to check in with us. She was feeling a little bit better and EMTs believe she had severe anxiety attack.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1484269&WAYBACKHISTORY=ON


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