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This is VAERS ID 1371505

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371505
VAERS Form:2
Age:13.0
Sex:Male
Location:Ohio
Vaccinated:2021-06-03
Onset:2021-06-03
Submitted:0000-00-00
Entered:2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Feeling abnormal, Loss of consciousness

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

Write-up: VS 121/64, HR 73, OxSat 98%. Vaccine received and pt. States he blacked out. No loss of consciousness, but foggy. Alert x 3. VS obtained when pt. Placed on cot and monitored by Fire fighter.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1371505&WAYBACKHISTORY=ON

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