VAERS ID: |
902464 (history) |
Form: |
Version 2.0 |
Age: |
42.0 |
Sex: |
Male |
Location: |
Louisiana |
Vaccinated: | 2020-12-15 |
Onset: | 2020-12-15 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-15 |
Vaccination / Manufacturer |
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,
Laboratory test normal,
Presyncope SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? 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. |