This is VAERS ID 2021990

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 1/14/2022

Vaccin­ation / Manu­facturer (2 vaccines)	Lot / Dose	Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH	FL3209 / 3	LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC.	3C8484 / N/A	LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Loss of consciousness, Pallor, Seizure, Tongue biting

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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: NKDA
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: Patient lost consciousness as observed by accompanying guardian. Per guardian, patient also had a short seizure and skin color turned pale. Episode lasted less than 1 minute. Pharmacist was alerted but patient already regained consciousness and did not need epinephrine or interventions. Recommended patient lower head in seated position to increase blood flow. Patient also bit tongue during episode. Recommended patient stay for another 15 minutes for observation. Followed up with guardian on Monday 1/10/22 and no further incidents reported.

New Search