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VAERS ID: 1708024

AGE: 21| SEX: M|State: RI

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

Symptoms

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

Vaccines

VAX DATE: 16 September 2021 | ONSET DATE: 16 September 2021 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • MODERNA
  • COVID19 (COVID19 (MODERNA))

        RECVDATE:
        17 September 2021
        CAGE_YR:
        21
        CAGE_MO:
        RPT_DATE:
        DIED:
        DATEDIED:
        L_THREAT:
        ER_VISIT:
        HOSPITAL:
        HOSPDAYS:
        X_STAY:
        DISABLE:
        RECOVD:
        Y
        LAB_DATA:
        V_ADMINBY:
        PHM
        OTHER_MEDS:
        CUR_ILL:
        HISTORY:
        PRIOR_VAX:
        SPLTTYPE:
        FORM_VERS:
        2
        TODAYS_DATE:
        17 September 2021
        BIRTH_DEFECT:
        OFC_VISIT:
        ER_ED_VISIT:
        Y
        ALLERGIES:
        V_FUNDBY:
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