This is VAERS ID 1858775

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History of Changes from the VAERS Wayback Machine

First Appeared on 11/12/2021

Vaccin­ation / Manu­facturer (2 vaccines)	Lot / Dose	Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH	FK5127 / 1	RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS	7J2CA / 1	LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Feeling abnormal, Head injury, Loss of consciousness, Urinary incontinence

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: SULFA EYE DROPS
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: 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.

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