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This is VAERS ID 1376354

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1376354
VAERS Form:2
Age:14.0
Sex:Male
Location:New York
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Nausea, Syncope, Visual impairment

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: No
Allergies: No known allergies.
Diagnostic Lab Data: No
CDC 'Split Type':

Write-up: Patient experienced nausea, faint, and slightly vision loss after 10 mins of administering the second dose of COVID shot. Heart rate was reported as 101/68 and pulse was reported as 79. Emergency service was declined by patient''s mom ( claim herself as a MD).

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1376354&WAYBACKHISTORY=ON


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