VAERS ID: 1558261

AGE: 12| SEX: M|STATE: KY (United States)

Description

Patient received vaccine, was sitting in waiting area and passed out not even 5 minutes after receiving the vaccine. Patient was sitting down at the time so he slid down his chair but mother caught him before he fell out of chair. Patient was out for a few moments then came to again. Patient was given water to help him. Mother and patient sat in waiting area until he felt better and communicated to her he was okay to leave and then they left to go shopping in the store.

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Symptoms

Loss of consciousness

Vaccines

VAX DATE: 08-14-2021| ONSET DATE: 08-14-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 2 COVID19 PFIZER\BIONTECH FC3180 IM LA

RECVDATE:08-14-2021
RPT_DATE:
CAGE_YR:12
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:
V_ADMINBY:PHM
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:08-14-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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