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This is VAERS ID 1371822

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371822
VAERS Form:2
Age:18.0
Sex:Male
Location:Alabama
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 EW0178 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Hyperhidrosis, Loss of consciousness, Nausea, Pallor, Refusal of treatment by patient, Gaze palsy

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: Peanuts, Shellfish
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Approximately 5 minutes after receiving the vaccine, the patient passed out and his eyes rolled back (possible seizure activity). This activity lasted for approximately 1 minute. Patient also felt dizzy, sweaty, nauseous, and became pale. Patient was given a cold ice pack to lower his body temperature. Patient was also given crackers for nausea, and a bag just incase he had to vomit. Patient''s mother was also here to tend to the patient. The mother also gave him clear fluids (sprite) to help with the nausea. After approximately 10 minutes, the patient was able to stand without feeling dizzy. He left the store with his mother to be watched closely (His mother is a nurse.) They also refused emergency medical services.

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