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This is VAERS ID 1992041

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Color Schemes (Before/After):

First Appeared on 1/7/2022

VAERS ID: 1992041
VAERS Form: 2
Age: 16.0
Sex: Male
Location: Virginia
Vaccinated: 2021-12-29
Onset: 2021-12-29
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer (2 vaccines) Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UJ685AA / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Hyperacusis, Pallor, Urticaria, Haemorrhage

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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient was given the Pfizer covid-19 vaccine in his left arm. He switched seats and I gave him his flu vaccine in his right arm. He started bleeding so I removed the bandage and held pressure with a cotton ball. The bleeding stopped and there was a welt and the patient started to feel lightheaded and like he was going to black out. Patient appeared pale and out of it. Called 911 and patient put head between knees and drank water. Laid on the floor with feet elevated. Vital signs assessed. Patient reported vision better but echoing still in ears mildly. Condition improved before arrival of EMS.

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