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This is VAERS ID 1693642

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1693642
VAERS Form:2
Age:37.0
Sex:Male
Location:Illinois
Vaccinated:2021-09-12
Onset:2021-09-12
Submitted:0000-00-00
Entered:2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cold sweat, Feeling hot, Hyperhidrosis, Loss of consciousness, Pallor, Tremor, Musculoskeletal stiffness, Eye movement disorder

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: After 10 minutes, patient got up took 2 steps and had to sit down. He then passed out, stiffened up and appeared to be seizure like (eyes in back of head, shaking, stiff). After reaching out to him, he responded to me within 30 seconds. He was pale, sweating, clammy, and hot. We gave him water, damp paper towel, and then seemed to do better. Paramedics were called and they treated him further. After he was responsive, he told me he has a phobia of needles, but did not mark anything on VAR form to let us know.

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