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This is VAERS ID 1696702

History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1696702
VAERS Form:2
Age:85.0
Sex:Male
Location:California
Vaccinated:2021-09-14
Onset:2021-09-14
Submitted:0000-00-00
Entered:2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 UN / IM

Administered by: Public      Purchased by: ??
Symptoms: Agitation, Chest pain, Feeling cold

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: At approximately 9 am Pt walked up to PHN and stated he was having chest pain pointing to left chest. Assisted to cot and PHN attempted to check BP, Pt refused stating he was cold. PHN explained that would need to call emergency services, called at 9:03 and reported incident. Pt denies Hx of cardiovascular disease or being on any medications. Pt stated he wanted to leave but needed a ride, states he walked to vaccine appt. Advised to wait for ambulance but declines and walked out of waiting area, police officer nearby and went out to talk with Pt, clinical lead also went out to talk with Pt and convinced to come back in and wait for ambulance. Pt refused to sit down and became agitated trying to leave and saw the ambulance and agreed to sit down. Paramedic spoke with Pt and he refused care from them,then ambulated out of clinic on his own volition, with steady gait During time here displays being a poor historian and appeared agitated when trying to offer care.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1696702&WAYBACKHISTORY=ON

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