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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1450003



Case Details

VAERS ID: 1450003 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Malaise, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Nausea immediately following vaccine - unknown vaccine in past
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received 1st dose of pfizer COVID vaccine 06/29/21. After administration, the patient and his family (brother and father) were instructed to wait the required 15 mins after receiving the vaccine. The patients brother and father stepped away to go to the bathroom while the patient stayed in the waiting area. The patient received the vaccine at 7:15p and the incident occurred at ~7:25p. The patient said they felt unwell to one of the techs in the pharmacy and they proceeded to get the pharmacist''s attention. The pharmacist approached the patient and proceeded asking questions regarding the patient''s symptoms. They patient stated they felt unwell and possibly needed to vomit. The pharmacist grabbed a trash can to give the patient and paged the father back to the pharmacy. The pharmacist stayed by the patient''s side until the father returned and she informed him of what was going on. The patient stated this had happened previously when they received a vaccine ~1 year ago so it wasn''t a first time occurrence. The pharmacist provided the patient with cold water and ensured they were okay to leave before letting them go after waiting the required 15 minutes. Patient is due back for the second dose on 7/20/21. Special precautions will be taken to ensure the patient is okay before leaving, including waiting 30 minutes due to a previous adverse reaction to the vaccine.


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