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This is VAERS ID 1328513

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1328513
VAERS Form:2
Age:15.0
Sex:Male
Location:Colorado
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 EW0187 / 1 - / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Syncope

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

Write-up: Within 3 minutes of vaccination, pt fainted. Immediately came to. Monitored for 20 minutes and then released pt as mom was comfortable with pt being ok. Pt experienced similar episode 2 years prior during x-rays.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1328513&WAYBACKHISTORY=ON


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