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This is VAERS ID 1330808

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1330808
VAERS Form:2
Age:13.0
Sex:Male
Location:New York
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 EW0178 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cold sweat, Dizziness, Skin warm, Syncope, Unresponsive to stimuli, Eye movement disorder, Middle ear effusion

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had a syncopal reaction: skin became hot and clammy, patient was dizzy, upon asking him to repeat a command or do a simple action (like wiggling fingers, lifting arm) he was not responding and his eyes were rolling to the back of his head and would not vocalize (when asked if ok, or what his symptoms were, or if he was having trouble breathing) at which time we called 911 since he was not responding verbally or physically. Had him sit, take off his mask, gave him water to sip, took BP (102/60), within 5 minutes he started to come back around, was able to follow command (wiggle fingers) vocalize that he could breathe fine, and felt that there was water behind his ears. His temperature to touch seemed to start to go back down, and once paramedics arrived they evaluated him and released him as "ok" within 10 minutes.

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