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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1745561

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Case Details

VAERS ID: 1745561 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: At approximately 1200 on 09/29/21 the employee arrived to the clinic. At approximately 1205 the employee was injected with the 2nd dose of Moderna in the left arm. At approximately 1216 the employee reported feeling ?slightly woozy?. At approximately 1217 vital signs were 98.5F, 100%O2, 63 Pulse, 110/82, 12 respirations. At approximately 1220 supervisor was called. Supervisor ordered team to observe the employee longer and to request the employee go home to consult with their personal physician. Strongly encouraged employee to go home and consult with physician. The employee refused to go home stating ?I am able to walk and drive, If I go home now I will be further behind?. At approximately 1230 sitting vitals 99% O2, 54 Pulse, 12 respirations, 110/78. Standing BP 112/80, 66 pulse. No apparent rash or itching was noted, denies breathing difficulties, denies chest pain, denies any medical history. Observed employee until approximately 1235. At this time employee was released back to work. Gait was steady, no difficulties bending over and raising back up. Encouraged employee to call staff if symptoms worsen or don?t improve. Encouraged employee to call 911 immediately if symptoms of anaphylaxis develops. A follow up call will be made between 1500-1600.


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