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This is VAERS ID 1749856

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/1/2021

VAERS ID: 1749856
VAERS Form:2
Age:35.0
Sex:Female
Location:New York
Vaccinated:2021-09-30
Onset:2021-09-30
Submitted:0000-00-00
Entered:2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Abdominal pain, Dizziness, Fatigue, Flushing, Hyperhidrosis, Hypotension, Nervousness, Syncope, Tremor, 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: Abdominal Pain-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Exhaustion / Lethargy-Mild, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Mild, Systemic: Hypotension-Mild, Systemic: Shakiness-Severe, Additional Details: Patient recieved Moderna Covid vaccine and was waiting for the 15 mins, friend came over to tell me that he friend was shaking, when I went over to the patient she was unresponsive. After about 15-20 seconds she was reponsive, after further discussion with the patient she said this has happened before when she gave blood, she said she was extremely nervous and thinks that is what caused the reaction BP was 90/60 at first after it was back to normal at 120/80. She did not want to call Emergency.

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