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This is VAERS ID 1848995

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First Appeared on 11/12/2021

VAERS ID: 1848995
VAERS Form: 2
Age: 7.0
Sex: Male
Location: California
Vaccinated: 2021-11-06
Onset: 2021-11-06
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer (2 vaccines) Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK1527 / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 3NA4M / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Fall, Loss of consciousness, Pallor, Skin warm

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Client received the Pfizer COVID vaccine (lot#FK1527) in the L deltoid and the Fluarix Quadrivalent Influenza Vaccine (Lot#3NA4M) in the R deltoid at approximately 1050 from vaccinator RN. After the client received both vaccines, he stood up to wait next to his mother who was receiving her COVID vaccine from the same vaccinator. Due to a limited supply of chairs at the mobile event there was not an available chair to allow the client to sit down while waiting with his mother. At approximately 1055, as the client was standing next to his mother, he began to slouch over the vaccination table and vaccinator RN''s assisted client to the ground. Client lost consciousness for approximately 2 seconds. RN assessed non obstructed airway, no respiratory distress, and raised the client''s legs while he was laying on the floor. RN assessed client who presented with mild pallor of the face, no diaphoresis, and pupils equal and reactive. RN took client vitals at 1103 with BP 100/60 in the L arm laying down, 70 HR, and 16 RR. Lead RN assessed client at 1103 presented A&O x4 and talking in full sentences, grip strong and equal, cap refill < 3 seconds, and skin pink and warm to touch. Client''s mother reported that the client ate breakfast at 0830 and had a muffin. Client denied dizziness, SOB, headache, numbness, or tingling. Client was assisted to zero-gravity chair and Lead RN advised that the client be observed for 30 minutes. Client''s father reported that he has a history of fainting but reported that the client has never fainted in the past. Lead RN provided client with water, juice, and graham crackers. Client took sips of the water and juice and ate his snacks. Client reported to Lead RN that he was "feeling good now" and denied any dizziness, SOB, headache, numbness, or tingling. RN reviewed when to f/u with PCP. At 1140 the client left the vaccine site with his parents. Client walked out of the vaccine site with a steady and symmetrical gait.

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