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This is VAERS ID 1775264

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First Appeared on 10/15/2021

VAERS ID: 1775264
VAERS Form:2
Age:63.0
Sex:Male
Location:Texas
Vaccinated:2021-10-09
Onset:2021-10-09
Submitted:0000-00-00
Entered:2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Aphasia, Cold sweat, Fall, Head injury, Hyperhidrosis, Loss of consciousness

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None reported
Preexisting Conditions: Diabetes, and Hypertension
Allergies: None reported
Diagnostic Lab Data: Unknown, no tests were performed under our care.
CDC 'Split Type':

Write-up: Patient was waiting for 15 minutes after vaccination outside of the pharmacy. He came up to the pharmacy looked like he was going to say something and then lost consciousness. He fell and landed on his head. He was bleeding from his head we put pressure on the wound and waited on EMT to get here. He was very sweaty and cold to the touch. He had trouble talking but was able to get across that he was diabetic and had not eaten anything today and that he had hypertension. EMS showed up and transported him to the hospital out of our care.

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