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This is VAERS ID 1376413

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1376413
VAERS Form:2
Age:20.0
Sex:Male
Location:Georgia
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 EW0180 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Fall, Syncope

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Systemic: Dizziness / Lightheadness-Mild, Additional Details: patient felt lightheaded during observation period. He fainted and fell to the ground but was responsive. the Nurse at the clinic took his vital signs. Pt stated that he did not eat nor drink prior to vaccine administration. We provided gatorade and monitered him for an additional 30 minutes

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