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This is VAERS ID 1367856

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1367856
VAERS Form:2
Age:13.0
Sex:Male
Location:North Carolina
Vaccinated:2021-06-01
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Fall, Head injury, Syncope, 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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Additional Details: Mom reports that patient has a history of fainting after vaccine administration. Patient complained of feeling dizzy and lightheaded after receiving Covid vaccine. Patient fell from standing position and hit his forehead against store aisle. NP was called by Pharmacist, to assist/evaluate. Patient alert and oriented upon NP arrival. BP 116/60, pulse 76, O2 sat 99% on room air. Patient with normal neuro exam. Patient returned to baseline.

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