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This is VAERS ID 1331246

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1331246
VAERS Form:2
Age:13.0
Sex:Male
Location:Maryland
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 EW0186 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dizziness, Nausea, Pallor, Presyncope

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: Pale, Nausea, lightheaded. B.P=84/60 history of vasovagal response after previous vaccination Vital signs returned to normal after approximately 40 minutes. Recorded by RN

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