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This is VAERS ID 1328059

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1328059
VAERS Form:2
Age:12.0
Sex:Male
Location:Texas
Vaccinated:2021-05-18
Onset:2021-05-18
Submitted:0000-00-00
Entered:2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Nervousness, Seizure

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:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Patient appear to have a mild seizure (faint, stiffness on the arm that got the vaccine injection, eye rolled) about less than 5 seconds. Patient became fully awake as being put to laying down on the floor. Patient was able to answer to all questions was asked. Patient stated that he was nervous and scared of getting the vaccine. Patient''s mother stated that he had fainting history of seeing cut or bleeding. The event occur 30 seconds after received that vaccine.

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