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This is VAERS ID 1368402

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1368402
VAERS Form:2
Age:14.0
Sex:Male
Location:New York
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 EW0180 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Fall, Head injury, Loss of consciousness, Palpitations

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: unknown
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Patient was administered the vaccine. After administration we stood talking to his mother who had questions. After about 2 minutes they turned to walk away and he lost consciousness and hit his head on a counter. I unfortunately did not witness him falling. He regained consciousness almost immediately and I told him he needed to stay laying down for a few minutes first. After a few minutes he said he felt fine and we moved him to a chair. Within a few minutes, he became ill again so we had him lay down again in the consultation room. He then laid there for about 15 minutes before we moved him to a chair. He stated that before he lost consciousness his heart was racing. His mother states he''s never had any problems with vaccinations in the past. After sitting for the second time he said he felt fine except where he hit his head which was a little sore. We contacted the father later that night and he said that he too had a similar episode with a needle stick a few years prior. The patient felt better later night per his father.

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