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This is VAERS ID 1487172

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1487172
VAERS Form:2
Age:25.0
Sex:Female
Location:California
Vaccinated:2021-07-18
Onset:2021-07-18
Submitted:0000-00-00
Entered:2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046821A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Hypotension, Injection site pain, Syncope, Unresponsive to stimuli, Fear of injection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
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: Site: Pain at Injection Site-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Hypotension-Medium, Additional Details: Patient passed out approximately 3 min after given the dose. While getting ready to conduct CPR, the patient started responding. Patient was able to be seated. Called 911 and the paramedics arrived. After examining the patient, paramedics told me that patient told them that she was only afraid of needles and they think the reaction is Psycho-Somatic. Patient blood pressure was low for a little while.

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