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This is VAERS ID 1697400

History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1697400
VAERS Form:2
Age:19.0
Sex:Male
Location:Arizona
Vaccinated:2021-09-14
Onset:2021-09-14
Submitted:0000-00-00
Entered:2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cold sweat, Deafness, Dizziness, Hyperhidrosis, Pallor, Visual impairment

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: unknown vaccine he also had it watching another get an IV
Other Medications: None
Current Illness: None reported.
Preexisting Conditions: None
Allergies: Patient reported no known allergies to medications, foods, or other products
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient was given Pfizer #1 at 5:20 PM he went into the waiting area with his mother. I was called to the area because he felt faint, he stated he could not see or hear us, he was diaphoretic, he had no breathing problems, no facial edema, no wheezing or stridor, he was pale and clammy. He continued to speak to us and was given water. He then went back into the exam room and rested on the table with legs elevated. He declined EMS. His mother noted he has had this type of reaction before when watching a person get an IV or getting an injection. He was alert and oriented x 4, stated that he felt well and ambulated with steady gait from the clinic with his mother.

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