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This is VAERS ID 1241656

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1241656
VAERS Form:2
Age:32.0
Sex:Male
Location:Georgia
Vaccinated:2021-04-21
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Loss of consciousness, Vital signs measurement

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: Syncope with all injections
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient with a history of syncope after injections of any kind. Afraid of needles. Approximately 7 minutes post injection patient passed out in observation. LOC less than 20 seconds. Awake and oriented x3 and VS stable and within normal limits. Dr. , medical director, consulted. No further orders. Observed for 30 minutes and wife called. Patient released to self. He will bring a driver for dose 2 and let staff know he has syncope with injections.


Changed on 5/7/2021

VAERS ID: 1241656 Before After
VAERS Form:2
Age:32.0
Sex:Male
Location:Georgia
Vaccinated:2021-04-21
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Loss of consciousness, Vital signs measurement

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: Syncope with all injections
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient with a history of syncope after injections of any kind. Afraid of needles. Approximately 7 minutes post injection patient passed out in observation. LOC less than 20 seconds. Awake and oriented x3 and VS stable and within normal limits. Dr. , medical director, consulted. No further orders. Observed for 30 minutes and wife called. Patient released to self. He will bring a driver for dose 2 and let staff know he has syncope with injections.


Changed on 5/14/2021

VAERS ID: 1241656 Before After
VAERS Form:2
Age:32.0
Sex:Male
Location:Georgia
Vaccinated:2021-04-21
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Loss of consciousness, Vital signs measurement

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: Syncope with all injections
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient with a history of syncope after injections of any kind. Afraid of needles. Approximately 7 minutes post injection patient passed out in observation. LOC less than 20 seconds. Awake and oriented x3 and VS stable and within normal limits. Dr. , medical director, consulted. No further orders. Observed for 30 minutes and wife called. Patient released to self. He will bring a driver for dose 2 and let staff know he has syncope with injections.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1241656&WAYBACKHISTORY=ON


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