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This is VAERS ID 904359

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 904359
VAERS Form:2
Age:19.0
Sex:Male
Location:West Virginia
Vaccinated:2020-12-19
Onset:2020-12-19
Submitted:0000-00-00
Entered:2020-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 RA / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Blood pressure increased, Dizziness, Dyspnoea, Fatigue, Heart rate increased, Respiratory arrest, Seizure

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: Losartan 50mg QD, Loratadine 10mg QD PRN, Albuterol Sulfate HFA (Proair Inhaler), Symbicort 160/4.5 Inhaler,
Current Illness: n/a
Preexisting Conditions: HBP, Exercise induced Asthma, Obesity
Allergies: Previous Allergic reaction when in school based health center- to Allergy Injection/shot, Morphine,
Diagnostic Lab Data: Called 911. EMTs came and took BP. He was not going to go to hospital. But felt off enough with shaky legs that it was determined best for him to go and be monitored. Pt was taken by ambulance to hospital. Monitored in ER about 10:30 to 12:00 Noon. Went home to rest and be watched carefully. I have spoken with his primary care physician. He has called him in an EpiPen.
CDC 'Split Type':

Write-up: Within 5 minutes, started feeling very tired and dizzy, leaned head back trying to relax. Approximately 15 minutes after vaccine had seizure lasting up to 15 seconds possibly. Brought to floor carefully. Then had small second seizure (about 5 seconds in duration). Difficulty Breathing immediately. Then extreme trouble breathing/stopped breathing , given 0.3 mg EpiPen in right thigh, gasped and began breathing again. Checked pulse (80 b/pm) then waited about 3 minutes and EMTs arrived. BP was 140/90 ish. Both higher but not terribly high.


Changed on 5/7/2021

VAERS ID: 904359 Before After
VAERS Form:2
Age:19.0
Sex:Male
Location:West Virginia
Vaccinated:2020-12-19
Onset:2020-12-19
Submitted:0000-00-00
Entered:2020-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 RA / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Blood pressure increased, Dizziness, Dyspnoea, Fatigue, Heart rate increased, Respiratory arrest, Seizure

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: Losartan 50mg QD, Loratadine 10mg QD PRN, Albuterol Sulfate HFA (Proair Inhaler), Symbicort 160/4.5 Inhaler,
Current Illness: n/a
Preexisting Conditions: HBP, Exercise induced Asthma, Obesity
Allergies: Previous Allergic reaction when in school based health center- to Allergy Injection/shot, Morphine, Morphine,
Diagnostic Lab Data: Called 911. EMTs came and took BP. He was not going to go to hospital. But felt off enough with shaky legs that it was determined best for him to go and be monitored. Pt was taken by ambulance to hospital. Monitored in ER about 10:30 to 12:00 Noon. Went home to rest and be watched carefully. I have spoken with his primary care physician. He has called him in an EpiPen.
CDC 'Split Type':

Write-up: Within 5 minutes, started feeling very tired and dizzy, leaned head back trying to relax. Approximately 15 minutes after vaccine had seizure lasting up to 15 seconds possibly. Brought to floor carefully. Then had small second seizure (about 5 seconds in duration). Difficulty Breathing immediately. Then extreme trouble breathing/stopped breathing , given 0.3 mg EpiPen in right thigh, gasped and began breathing again. Checked pulse (80 b/pm) then waited about 3 minutes and EMTs arrived. BP was 140/90 ish. Both higher but not terribly high.


Changed on 5/14/2021

VAERS ID: 904359 Before After
VAERS Form:2
Age:19.0
Sex:Male
Location:West Virginia
Vaccinated:2020-12-19
Onset:2020-12-19
Submitted:0000-00-00
Entered:2020-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 RA / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Blood pressure increased, Dizziness, Dyspnoea, Fatigue, Heart rate increased, Respiratory arrest, Seizure

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: Losartan 50mg QD, Loratadine 10mg QD PRN, Albuterol Sulfate HFA (Proair Inhaler), Symbicort 160/4.5 Inhaler,
Current Illness: n/a
Preexisting Conditions: HBP, Exercise induced Asthma, Obesity
Allergies: Previous Allergic reaction when in school based health center- to Allergy Injection/shot, Morphine, Morphine,
Diagnostic Lab Data: Called 911. EMTs came and took BP. He was not going to go to hospital. But felt off enough with shaky legs that it was determined best for him to go and be monitored. Pt was taken by ambulance to hospital. Monitored in ER about 10:30 to 12:00 Noon. Went home to rest and be watched carefully. I have spoken with his primary care physician. He has called him in an EpiPen.
CDC 'Split Type':

Write-up: Within 5 minutes, started feeling very tired and dizzy, leaned head back trying to relax. Approximately 15 minutes after vaccine had seizure lasting up to 15 seconds possibly. Brought to floor carefully. Then had small second seizure (about 5 seconds in duration). Difficulty Breathing immediately. Then extreme trouble breathing/stopped breathing , given 0.3 mg EpiPen in right thigh, gasped and began breathing again. Checked pulse (80 b/pm) then waited about 3 minutes and EMTs arrived. BP was 140/90 ish. Both higher but not terribly high.

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