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This is VAERS ID 1912790

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History of Changes from the VAERS Wayback Machine

Color Schemes (Before/After):

First Appeared on 12/3/2021

VAERS ID: 1912790
VAERS Form: 2
Age: 10.0
Sex: Male
Location: North Dakota
Vaccinated: 2021-12-01
Onset: 2021-12-01
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer (2 vaccines) Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 1 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7378JA / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Dizziness, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: Common cold in the last month.
Preexisting Conditions: n/a
Allergies: NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Dizzy and Faint, pt seated and given a cold pack with orange juice and crackers. Outcome: pt reports feeling "better than before" after 15 minutes.

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