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This is VAERS ID 1310900

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1310900
VAERS Form:2
Age:17.0
Sex:Male
Location:Unknown
Vaccinated:2021-05-04
Onset:2021-05-04
Submitted:0000-00-00
Entered:2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / UNK LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Dizziness, Hyperhidrosis, Pallor, Presyncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient came for second dose Pfizer COVID vaccine at location. He got his vaccine at 315pm. Immediately following the immunization he had a vaso-vagal reaction. He became light-headed, diaphoretic and pale. Dr. examined him and he was walked to a litter to lay down. He was given an ice pack and water. His legs were lifted. He felt better after laying down. He left for home at 235pm after the symptoms resolved.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1310900&WAYBACKHISTORY=ON


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