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This is VAERS ID 1378562

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1378562
VAERS Form:2
Age:29.0
Sex:Male
Location:Virginia
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Blood glucose, Heart rate decreased, Loss of consciousness, Cardiac monitoring

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: unknown
Allergies: none known
Diagnostic Lab Data: EMTs checked blood glucose, heart rate, blood pressure. Heart monitor applied due to low heart rate.
CDC 'Split Type':

Write-up: Patient received vaccine and within 5 minutes he lost consciousness. He came to and was oriented to place and time. Called 911. He was monitored and refused to go to hospital. He left pharmacy about 30-45 minutes later and felt ok.

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