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VAERS ID: | 902464 |
VAERS Form: | 2 |
Age: | 42.0 |
Sex: | Male |
Location: | Louisiana |
Vaccinated: | 2020-12-15 |
Onset: | 2020-12-15 |
Submitted: | 0000-00-00 |
Entered: | 2020-12-15 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EH9899 / UNK | LA / IM |
Administered by: Private Purchased by: ??
Symptoms: Dizziness, Electrocardiogram normal, Hyperhidrosis, Presyncope, Laboratory test normal
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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Basic Chemistry, EKG, and vitals were all normal on 12/15/2020.
CDC 'Split Type':
Write-up: within 15 minutes progressive light-headedness leading to near-syncope and diaphoresis. After 20 minutes symptoms subsided.
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