VAERS ID: 1858775

AGE: 9| SEX: M|STATE: KY (United States)

Description

After receiving both vaccines patient was walking around the store with his mom and told her he didn't feel good. Patient proceeded to pass out and hit his head. Patient peed his pants and felt light-headed until the ambulance arrived and they checked him out.

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

Dizziness, Urinary incontinence, Loss of consciousness, Feeling abnormal, Head injury

Vaccines

VAX DATE: 11-10-2021| ONSET DATE: 11-10-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH FK5127 IM RA
INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) 1 FLU4 GLAXOSMITHKLINE BIOLOGICALS 7J2CA IM LA

RECVDATE:11-10-2021
RPT_DATE:
CAGE_YR:9
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:none
V_ADMINBY:PHM
OTHER_MEDS:NONE
CUR_ILL:NONE
HISTORY:NONE
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:11-10-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:SULFA EYE DROPS
V_FUNDBY:

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