VAERS ID: 1708034

AGE: 28| SEX: M|STATE: MO (United States)

Description

Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Visual Changes/Disturbances-Mild, Additional Details: After administration he was fine for about 30 seconds. While in the chair he tilted his head back and became rigid then slumped over. I tried to awake him but he did not respond and became pale. His pulse was weak. I yelled into the pharmacy to call 911 . When I looked back his hands flew up in the air and he looked around. Upon talking to him he had passed out after piercings but never a shot. The EMTs checked his vitals they were ok and his parents picked him up.

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, Pallor, Hyperhidrosis, Flushing, Unresponsive to stimuli, Muscle rigidity, Visual impairment, Pulse abnormal

Vaccines

VAX DATE: 09-12-2021| ONSET DATE: 09-12-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 2 COVID19 PFIZER\BIONTECH FC3184 IM LA

RECVDATE:09-17-2021
RPT_DATE:
CAGE_YR:28
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:09-17-2021
BIRTH_DEFECT:U
OFC_VISIT:Y
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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