This is VAERS ID 1831616

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History of Changes from the VAERS Wayback Machine

First Appeared on 11/5/2021

Vaccin­ation / Manu­facturer (2 vaccines)	Lot / Dose	Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH	FH8027 / 1	LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS	34YN4 / N/A	LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Loss of consciousness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient passed out in store about 1 hour after his vaccines. Patient was assessed by EMS and it was determined patient had only eaten noodles a few hours before vaccines and was light-headed due to not having eating in combination with vaccines. Patient left with parents on his own accord.

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