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This is VAERS ID 2019711

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Color Schemes (Before/After):

First Appeared on 1/14/2022

VAERS ID: 2019711
VAERS Form: 2
Age: 11.0
Sex: Male
Location: Arizona
Vaccinated: 2022-01-07
Onset: 2022-01-08
Submitted: 0000-00-00
Entered: 2022-01-09
Vaccin­ation / Manu­facturer (2 vaccines) Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Disorientation, Dizziness, Loss of consciousness, Ocular hyperaemia, Pyrexia, Syncope

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 known
Diagnostic Lab Data: We monitored patient closely all day and he seemed alert and felt normal (the mild fever went away and did not return as well). We did not seek medical care.
CDC 'Split Type':

Write-up: Patient was getting a haircut when he slumped over in the chair and passed out unconscious for 15-20 seconds. When he came to, his eyes were blood shot and he was disoriented (not sure what happened). He said that he suddenly became dizzy before blacking out. This is the first time patient has ever blacked out. He had eaten a large meal roughly 2-3 hours prior to the event and was adequately hydrated (did not appear to be a blood sugar or hydration issue). A few hours later he seemed to be running a mild fever and was given 200mg ibuprofen. Otherwise he was fine the rest of the day.

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