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This is VAERS ID 908187

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 908187
VAERS Form:2
Age:53.0
Sex:Male
Location:Unknown
Vaccinated:2020-12-23
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Anxiety, Tachycardia

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: Pt c/o tachycardia and maybe anxiety. Pt is an MD. Tachycardia at 15 mins post vaccine- radial pulse 132 and BP 150/90. Denied other symptoms. Rechecked in 15 mins and HR 84-91 and BP 154/95. Continued to deny any other symptoms to include CP or SOB. No change in mental status. Declined treatment in ED. Kept and monitored for 15 more mins. and left 45 mins post vaccine. Continued to state maybe he was anxious


Changed on 5/7/2021

VAERS ID: 908187 Before After
VAERS Form:2
Age:53.0
Sex:Male
Location:Unknown
Vaccinated:2020-12-23
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Anxiety, Tachycardia

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: Pt c/o tachycardia and maybe anxiety. Pt is an MD. Tachycardia at 15 mins post vaccine- radial pulse 132 and BP 150/90. Denied other symptoms. Rechecked in 15 mins and HR 84-91 and BP 154/95. Continued to deny any other symptoms to include CP or SOB. No change in mental status. Declined treatment in ED. Kept and monitored for 15 more mins. and left 45 mins post vaccine. Continued to state maybe he was anxious


Changed on 5/21/2021

VAERS ID: 908187 Before After
VAERS Form:2
Age:53.0
Sex:Male
Location:Unknown
Vaccinated:2020-12-23
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Anxiety, Tachycardia

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: Pt c/o tachycardia and maybe anxiety. Pt is an MD. Tachycardia at 15 mins post vaccine- radial pulse 132 and BP 150/90. Denied other symptoms. Rechecked in 15 mins and HR 84-91 and BP 154/95. Continued to deny any other symptoms to include CP or SOB. No change in mental status. Declined treatment in ED. Kept and monitored for 15 more mins. and left 45 mins post vaccine. Continued to state maybe he was anxious

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