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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1388154



Case Details

VAERS ID: 1388154 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Headache
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine given at 5:19 pm. After the vaccine, mom took pt and walked around the store rather than stay in the waiting area. They returned at approximately 5:45 pm, because pt was complaining of a bad headache rating pain 6/10. He denied any other symptoms. We had him sit down in the waiting area and gave him a bottle of water. He started feeling lightheaded a few minutes later and was moved to an exam room. I had him lay down on the exam table. At approx. 5:55pm, I checked his BP while he was laying down and it was 104/62. He reported feeling a little better, so I had him sit up. Rechecked BP and it was 108/70. He reported dizziness had resolved and headache was now 5/10. At some point while I was not with the pt, mom gave him some Aleve, but I don''t know what time. Mom decided to take him home at that point.


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