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This is VAERS ID 1366337

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1366337
VAERS Form:2
Age:21.0
Sex:Male
Location:California
Vaccinated:2021-06-01
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Condition aggravated, Cyanosis, Pulse abnormal, Respiratory arrest, Resuscitation, Seizure, Urinary incontinence, Immediate post-injection reaction

Life Threatening? Yes
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: Unknown
Current Illness: No known illnesses or health conditions
Preexisting Conditions: History of seizures not indicated on VAR but noted after event.
Allergies: No known allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had a seizure about 40 seconds after receiving the COVID19 (Pfizer) vaccine. He urinated, and became cyanotic, not breathing and faint pulse. CPR as initiated and 911 called. Patient regained consciousness after 30 compressions and was taken to the hospital after ambulance arrived.

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