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VAERS ID: | 2446442 |
VAERS Form: | 2 |
Age: | 13.0 |
Sex: | Male |
Location: | Indiana |
Vaccinated: | 2022-09-15 |
Onset: | 2022-09-15 |
Submitted: | 0000-00-00 |
Entered: | 2022-09-15 |
Vaccination / Manufacturer (2 vaccines) | Lot / Dose | Site / Route |
COVID19-2: COVID19 (COVID19 (PFIZER-BIONTECH BIVALENT)) / PFIZER/BIONTECH | GH9694 / 4 | LA / IM |
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS | G2979 / 1 | RA / IM |
Administered by: Pharmacy Purchased by: ??
Symptoms: Feeling hot, Hypoaesthesia, Loss of consciousness, Vomiting, Seizure like phenomena
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Patient began feeling very warm about 4 minutes after receiving the vaccine combination. Patient was waiting in the car for the 15 minute suggested wait period. Patient''s caregiver stated that about 5 minutes after receiving the vaccines, the patient blacked out in a seizure like behavior and was out for about 25 seconds. When he became responsive, he vomited and complained of an overall numb feeling. Patient''s blood pressure was checked and it was within normal range. Pulse was normal. Respiration was mostly normal. Over the course of about 10 mintues, the patient was beginning to feel better. Within 30 to 45 minutes from vaccination, the patient was feeling normal.
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