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This is VAERS ID 1464563

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1464563
VAERS Form:2
Age:25.0
Sex:Male
Location:Illinois
Vaccinated:2021-07-03
Onset:2021-07-03
Submitted:0000-00-00
Entered:2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Patient fainted and fell on the ground about 10 minutes after the vaccine was administered. We called the ambulance and they came 10 minutes later and checked his vitals. Patient did not leave on the ambulance.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1464563&WAYBACKHISTORY=ON


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