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This is VAERS ID 1696935

History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1696935
VAERS Form:2
Age:22.0
Sex:Female
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 034C21A / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Chest discomfort, Hypoaesthesia, Nausea, Pain in extremity

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: banana, kiwi fruit, pineapple
Diagnostic Lab Data: Vital signs taken: BP 134/84, HR 55, O2sat 100% Room Air.
CDC 'Split Type':

Write-up: 9/14/21 Pt received 1st dose of Moderna vaccine at 10:45 AM . After 15 mins of observation, patient started to have Rt arm soreness and nausea. Then patient developed Rt arm numbness and chest pressure. Patient had some crackers and orange juice . Observed patient until 11:55 AM with no symptoms improvement , then RN transported patient to ER for further evaluation.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1696935&WAYBACKHISTORY=ON

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