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This is VAERS ID 1369085

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1369085
VAERS Form:2
Age:13.0
Sex:Male
Location:Ohio
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 EW0182 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Blindness, Dizziness, Fall, Gait disturbance, Head injury, Headache

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: N/A
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None that we are aware of at this time.
CDC 'Split Type':

Write-up: Patient became dizzy/started losing his vision fairly quickly after receiving the vaccine. He kept repeating he couldn''t see. He stumbled forward then fell down. Patient did hit his head. Store associate got him up and into a chair and started asking him questions. Mom stated he had just received vaccine. They were not told by the pharmacist on duty to stay to be monitored for 15 minutes after. He did say that he had a headache. Gave the patient some water, had him move his arm around, and monitored patient until pharmacy closed.

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