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This is VAERS ID 1328926

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1328926
VAERS Form:2
Age:12.0
Sex:Male
Location:Unknown
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 EW0172 / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Syncope

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: Pt dad states that patient fainted upon receiving the vaccine. Evaluated by EMS-Refusal to transport.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1328926&WAYBACKHISTORY=ON


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