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This is VAERS ID 1474432

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1474432
VAERS Form:2
Age:21.0
Sex:Male
Location:Illinois
Vaccinated:2021-07-15
Onset:2021-07-15
Submitted:0000-00-00
Entered:2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Loss of consciousness, Seizure like phenomena

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: Patient reported same event occurred after he received HPV vaccine.
Other Medications: n/a
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Immediately after IM administration of vaccine, patient lost consciousness and seemed to be seizing while seating in his chair. Patient regained consciousness within the same minute. Pharmacy manager was immediately called over. We gave the patient water and had him wait for observation for 30 minutes post vaccine administration. Patient mentioned that he had similar syncope episode after receiving HPV vaccine.

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