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This is VAERS ID 1376014

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1376014
VAERS Form:2
Age:14.0
Sex:Male
Location:New Jersey
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Loss of consciousness, Tremor

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: unknown
Preexisting Conditions: asthma
Allergies: no
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: after dose was administered by began to shake and then lost consciousness, patient was laid on floor were he immediately regained consciousness, when he felt up to it he was sat in his chair, given energy drink and water and instructed to place his head between his knees if he felt light headed, he was then monitored for the next 30 mins without further incident

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