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This is VAERS ID 1330936

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1330936
VAERS Form:2
Age:13.0
Sex:Male
Location:Unknown
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 EW0183 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Cyanosis, Disorientation, Fatigue, Nausea, Pulse abnormal, Seizure, Unresponsive to stimuli

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pulse 83 Respirations 18 SPO2 100% BP 90/60 Exam was abnormal, patient felt fatigue and nauseous VSS Heart and lung sounds normal
CDC 'Split Type':

Write-up: Patient had convulsive seizure, became unresponsive and was cyanotic, sternal rub, patient opened eyes. Heart rate was thready. Patient felt nauseous. Patient was disoriented for 1min and quickly regained orientation. Patient was given water, patient laid on the floor. Discharged to ER Past Medical Hx Hx of seizure at age 4

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