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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 2057988 |
VAERS Form: | 2 |
Age: | 14.0 |
Sex: | Male |
Location: | Pennsylvania |
Vaccinated: | 2022-01-23 |
Onset: | 2022-01-23 |
Submitted: | 0000-00-00 |
Entered: | 2022-01-23 |
Vaccination / Manufacturer (2 vaccines) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | FK9729 / 1 | RA / IM |
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. | 308498 / 1 | LA / IM |
Administered by: Pharmacy Purchased by: ??
Symptoms: 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: n/a
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: n/a
CDC 'Split Type':
Write-up: patient received a flu vaccination and a Pfizer covid vaccination. Patient fainted after vaccination but quickly regained consiousness
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