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This is VAERS ID 2057988

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History of Changes from the VAERS Wayback Machine

Color Schemes (Before/After):

First Appeared on 1/28/2022

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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