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This is VAERS ID 1741419

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/1/2021

VAERS ID: 1741419
VAERS Form:2
Age:29.0
Sex:Female
Location:Texas
Vaccinated:2021-09-27
Onset:2021-09-27
Submitted:0000-00-00
Entered:2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Syncope, Unresponsive to stimuli

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: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Additional Details: The patient was seated in the waiting area. Approx 5 minutes after receiving the vaccine, the patient fainted. She woke up on the floor laying on her back after a few seconds. She said she was not hurt and was in no pain. She said she "always" faints or feels like fainting after getting a shot, but she had not reported this before the event occurred. We gave her water and a snack and encounraged her to stay seated for 30 minutes. She refused to let us take vitals, re-stating that she was fine.

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