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This is VAERS ID 1705935

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1705935
VAERS Form:2
Age:29.0
Sex:Female
Location:California
Vaccinated:2021-09-11
Onset:2021-09-11
Submitted:0000-00-00
Entered:2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Asthenia, Chills, Dizziness, Headache, Nausea, Seizure, Syncope, Unresponsive to stimuli

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: Systemic: Chills-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Headache-Mild, Systemic: Nausea-Mild, Systemic: Seizure-Mild, Systemic: Weakness-Mild, Additional Details: patient had a seizure about 10 minutes after receiving the moderna vaccine. the seizure episode lasted 30-60 seconds. the patient regained consciousness, but experienced lightheadedness, weakness, nausea, headache, and chills. patient was provided with a benadryl 25 mg, orange juice, and a cookie. patient felt better afterward. patient will follow up with a physician at an urgent care.

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