VAERS ID: 1708024

AGE: 21| SEX: M|STATE: RI (United States)

Description

Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Additional Details: PT PASSED OUT SOON AFTER VACCINE STAYED IN CHAIR DID NOT FALL CAME TO IN A FEW SECONDS

Open in Wayback Machine
(If this is a foreign report without a description you will be able to read the description in the Wayback Machine on Medalerts if the report became public for the first time before November 18, 2022.)

Symptoms

Syncope, Hyperhidrosis, Loss of consciousness, Flushing, Unresponsive to stimuli

Vaccines

VAX DATE: 09-16-2021| ONSET DATE: 09-16-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 050E21A IM LA

RECVDATE:09-17-2021
RPT_DATE:
CAGE_YR:21
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:
V_ADMINBY:PHM
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:09-17-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:Y
ALLERGIES:
V_FUNDBY:

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OpenVAERS is a private organization that posts publicly available CDC/FDA data of injuries reported post-vaccination. Reports are not proof of causality.