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This is VAERS ID 1367857

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1367857
VAERS Form:2
Age:17.0
Sex:Male
Location:Georgia
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 EVV0177 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Seizure, Syncope, Unresponsive to stimuli

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Systemic: Fainting / Unresponsive-Severe, Systemic: patient had a seizure about 5 mins following adminstration-Severe, Systemic: Seizure-Severe, Additional Details: ems was called and patient was evaluated and pt was cleared with normal vitals and alert from ems parent refused to go to er i tried calling to follow up with patient and now answer on best contact number

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1367857&WAYBACKHISTORY=ON


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