VAERS ID: 1388610

AGE: 14| SEX: M|STATE: MN (United States)

Description

Patient received vaccine at 11:14 and had an episode of syncope of at approximately 11:20. Patient received a laceration on his chin approximately 2 cm in length. He was rolled on his back and left supine, direct pressure was placed on the laceration until EMT arrived. Patient's mother denied EMT transport and did transport the patient to the Emergency Department for assessment.

Open in Wayback Machine
(If this is a foreign report without a description you will be able to read the description in the Wayback Machine on Medalerts if the report became public for the first time before November 18, 2022.)

Symptoms

Syncope, Skin laceration

Vaccines

VAX DATE: 06-10-2021| ONSET DATE: 06-10-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 5 COVID19 PFIZER\BIONTECH EW0177 IM LA

RECVDATE:06-10-2021
RPT_DATE:
CAGE_YR:14
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:
V_ADMINBY:PVT
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:06-10-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:Y
ALLERGIES:No known allergies
V_FUNDBY:

Questions? Comments? Bugs?
[email protected]
Due to the high volume of inquiries, please be patient with response times.

AND PLEASE read the FAQ first.

OpenVAERS is a private organization that posts publicly available CDC/FDA data of injuries reported post-vaccination. Reports are not proof of causality.