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This is VAERS ID 1484284

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1484284
VAERS Form:2
Age:33.0
Sex:Male
Location:California
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 007C21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Asthenia, Chills, Dizziness, Fatigue, Flushing, Gait inability, Hyperhidrosis, Lethargy, Paraesthesia, Visual impairment, Hypoacusis, Impaired driving ability

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: Chills-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Tingling (specify: facial area, extemities)-Medium, Systemic: Visual Changes/Disturbances-Medium, Systemic: Weakness-Medium, Additional Details: Within 5 minutes of receiving vaccine, patient alerted store personnel that he was "seeing stars" and have impaired hearing (sounds like underwater). Within 10 minutes, he started feeling chills and sweating; he reported feeling weak, unable to walk or drive and had tingling on his forearms. He was offered acetaminophen and Benadryl. He refused Benadryl but took on tablet of acetaminophen 500mg. At about 25 minutes post-injection, he reported feeling better and refused paramedics.

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