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This is VAERS ID 1474476

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1474476
VAERS Form:2
Age:15.0
Sex:Male
Location:Arkansas
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 EW0181 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chills, Feeling cold, Loss of consciousness, Nausea, Syncope, Tinnitus

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
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 passed out around 5 minutes past dose. He did not have a complete loss of consciousness. Lowered him to floor, elevated legs, and slowly lowered head to ground. complained of being cold, had shivers, and complained of ringing in the ears and nausea. once resolved, sat him up and observed again. around 30 minutes past vaccine had a second fainting spell, to which called 911 for observation. Patient completely resolved and left with mom and EMS walked him to her car.

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