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This is VAERS ID 1330774

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1330774
VAERS Form:2
Age:13.0
Sex:Male
Location:New Hampshire
Vaccinated:2021-05-19
Onset:2021-05-19
Submitted:0000-00-00
Entered:2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Fall, Head injury, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient received dose of vaccine. While standing patient experienced syncope and fell to floor. Bumped head against wall while falling but was caught by father before hitting floor. He quickly regained consciousness and had a strong pulse.
Current Illness: none known
Preexisting Conditions: none known
Allergies: no know allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received dose of vaccine. While standing patient experienced syncope and fell to floor. Bumped head against wall while falling but was caught by father before hitting floor. He quickly regained consciousness and had a strong pulse. He remained on the floor with feet elevated for 10 minutes. He then sat in chair IN front of pharmacy for an additional 15 minutes. At that point he felt fine and left the pharmacy with his father.

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