National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 919036

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 919036
VAERS Form:2
Age:89.0
Sex:Male
Location:Indiana
Vaccinated:2020-12-28
Onset:2020-12-28
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Bladder catheter replacement, Dehydration, Hyperhidrosis, Loss of consciousness, Nausea, Speech disorder, Vomiting

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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: unknown
Preexisting Conditions: Unknown
Allergies: Sulfa antibiotics
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient with extreme nausea and vomiting that started soon after receiving the Moderna vaccine. Patient with loss of consciousness, diaphoresis and garbled speech during a foley catheter exchange thought to be from dehydration. Patient was admitted to Hospital for observation for 2 days


Changed on 5/7/2021

VAERS ID: 919036 Before After
VAERS Form:2
Age:89.0
Sex:Male
Location:Indiana
Vaccinated:2020-12-28
Onset:2020-12-28
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Bladder catheter replacement, Dehydration, Hyperhidrosis, Loss of consciousness, Nausea, Speech disorder, Vomiting

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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: unknown
Preexisting Conditions: Unknown
Allergies: Sulfa antibiotics antibiotics
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient with extreme nausea and vomiting that started soon after receiving the Moderna vaccine. Patient with loss of consciousness, diaphoresis and garbled speech during a foley catheter exchange thought to be from dehydration. Patient was admitted to Hospital for observation for 2 days


Changed on 5/14/2021

VAERS ID: 919036 Before After
VAERS Form:2
Age:89.0
Sex:Male
Location:Indiana
Vaccinated:2020-12-28
Onset:2020-12-28
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Bladder catheter replacement, Dehydration, Hyperhidrosis, Loss of consciousness, Nausea, Speech disorder, Vomiting

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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: unknown
Preexisting Conditions: Unknown
Allergies: Sulfa antibiotics antibiotics
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient with extreme nausea and vomiting that started soon after receiving the Moderna vaccine. Patient with loss of consciousness, diaphoresis and garbled speech during a foley catheter exchange thought to be from dehydration. Patient was admitted to Hospital for observation for 2 days

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=919036&WAYBACKHISTORY=ON


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