VAERS ID: 1509247

AGE: 13| SEX: M|STATE: CT

Description

Systemic: Fainting / Unresponsive-Medium, Systemic: Visual Changes/Disturbances-Mild, Additional Details: Pt informed to sit after receiving vaccine mom walked away then pt got up and started walking and passed out in aisle walking to mom and scraped his elbow. pt seated and had something to drink, felt dizzy and felt vision was blurry upon awake. Informed mom we could call paramedics but mom felt he was okay. Observed for 30 min after fainting incident, felt much better, vision no longer was a problem and no longer light headed. Mom told to call Dr. in case pt hit head, said to observe him

Symptoms

Dizziness, Joint injury, Loss of consciousness, Syncope, Unresponsive to stimuli, Vision blurred, Visual impairment

Vaccines

VAX DATE: 07-27-2021| ONSET DATE: 07-27-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH fa6780 IM LA

RECVDATE:07-28-2021
RPT_DATE:
CAGE_YR:13
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:U
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:2
TODAYS_DATE:07-28-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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