National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 919022

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 919022
VAERS Form:2
Age:28.0
Sex:Male
Location:Maryland
Vaccinated:2020-09-02
Onset:2020-09-02
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blindness unilateral, Echocardiogram, Electrocardiogram, Electrocardiogram ambulatory, Pyrexia, Tachycardia, Ophthalmological examination, Computerised tomogram coronary artery, Autoantibody positive, Postural orthostatic tachycardia syndrome, Magnetic resonance imaging brain

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Dutastride 0.5 mg/day, Wellbutrin XL 300 mg/day, Truvada (emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg)/day.
Current Illness:
Preexisting Conditions:
Allergies: doxycycline-gastrointestinal.
Diagnostic Lab Data: Eye exam, MRI of brain and orbits, Holter monitor, EKG, Echocardiogram, CT cardiac calcium score.
CDC 'Split Type':

Write-up: Complete loss of vision in the left eye 12 hours after receiving second dose (Moderna mRNA-1273) while having a fever of 102 F for 6 hours. Loss of vision lasted for 1 minute. Loss of vision occurred while standing. Referral to primary care and ophthalmology specialist found normal eye exam and MRI of orbits but presence of tachycardia especially while standing (fluctuations between 60 beats at rest/laying down to 130 beats per minute standing). Postural tachycardia syndrome (POTS) is suspected. Currently pursuing cardiac workup with cardiologist and Covid POTS specialist. POTS specialist believes autoantibody development after vaccination could be suspected as recovering covid patients similarly present to clinic with POTS like symptoms.


Changed on 5/7/2021

VAERS ID: 919022 Before After
VAERS Form:2
Age:28.0
Sex:Male
Location:Maryland
Vaccinated:2020-09-02
Onset:2020-09-02
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blindness unilateral, Echocardiogram, Electrocardiogram, Electrocardiogram ambulatory, Pyrexia, Tachycardia, Ophthalmological examination, Computerised tomogram coronary artery, Autoantibody positive, Postural orthostatic tachycardia syndrome, Magnetic resonance imaging brain

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Dutastride 0.5 mg/day, Wellbutrin XL 300 mg/day, Truvada (emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg)/day.
Current Illness:
Preexisting Conditions:
Allergies: doxycycline-gastrointestinal. doxycycline-gastrointestinal.
Diagnostic Lab Data: Eye exam, MRI of brain and orbits, Holter monitor, EKG, Echocardiogram, CT cardiac calcium score.
CDC 'Split Type':

Write-up: Complete loss of vision in the left eye 12 hours after receiving second dose (Moderna mRNA-1273) while having a fever of 102 F for 6 hours. Loss of vision lasted for 1 minute. Loss of vision occurred while standing. Referral to primary care and ophthalmology specialist found normal eye exam and MRI of orbits but presence of tachycardia especially while standing (fluctuations between 60 beats at rest/laying down to 130 beats per minute standing). Postural tachycardia syndrome (POTS) is suspected. Currently pursuing cardiac workup with cardiologist and Covid POTS specialist. POTS specialist believes autoantibody development after vaccination could be suspected as recovering covid patients similarly present to clinic with POTS like symptoms.


Changed on 5/14/2021

VAERS ID: 919022 Before After
VAERS Form:2
Age:28.0
Sex:Male
Location:Maryland
Vaccinated:2020-09-02
Onset:2020-09-02
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blindness unilateral, Echocardiogram, Electrocardiogram, Electrocardiogram ambulatory, Pyrexia, Tachycardia, Ophthalmological examination, Computerised tomogram coronary artery, Autoantibody positive, Postural orthostatic tachycardia syndrome, Magnetic resonance imaging brain

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Dutastride 0.5 mg/day, Wellbutrin XL 300 mg/day, Truvada (emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg)/day.
Current Illness:
Preexisting Conditions:
Allergies: doxycycline-gastrointestinal. doxycycline-gastrointestinal.
Diagnostic Lab Data: Eye exam, MRI of brain and orbits, Holter monitor, EKG, Echocardiogram, CT cardiac calcium score.
CDC 'Split Type':

Write-up: Complete loss of vision in the left eye 12 hours after receiving second dose (Moderna mRNA-1273) while having a fever of 102 F for 6 hours. Loss of vision lasted for 1 minute. Loss of vision occurred while standing. Referral to primary care and ophthalmology specialist found normal eye exam and MRI of orbits but presence of tachycardia especially while standing (fluctuations between 60 beats at rest/laying down to 130 beats per minute standing). Postural tachycardia syndrome (POTS) is suspected. Currently pursuing cardiac workup with cardiologist and Covid POTS specialist. POTS specialist believes autoantibody development after vaccination could be suspected as recovering covid patients similarly present to clinic with POTS like symptoms.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=919022&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166