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This is VAERS ID 1757896

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1757896
VAERS Form:2
Age:51.0
Sex:Female
Location:Virginia
Vaccinated:2021-10-03
Onset:2021-10-03
Submitted:0000-00-00
Entered:2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 RA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chest discomfort, Chest pain, Cold sweat, Dizziness, Dysphagia, Dyspnoea, Feeling hot, Flushing, Hyperhidrosis, Hyperventilation, Nausea, Nervousness, Throat tightness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Allergic: Difficulty Breathing-Medium, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Mild, Systemic: Chest Tightness / Heaviness / Pain-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Flushed / Sweating-Medium, Systemic: Hyperventilation-Mild, Systemic: Nausea-Medium, Additional Details: Approximately 5 minutes after administration patient appeared "clammy" upon asking patient how she felt she reported feeling very hot and nauseous. Patient initially reported reservations about getting the shot prior to administration and was "very nervous about having to get it." Roughly 10 minutes after administration patient was getting short of breath, breathing rapidly, and appeared very distraught. Told patient epipen was available and patient requested it, breathing became easier after.

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