Page breadcrumb nav

VAERS Report 2157331

Case Report Section

Vaer Report Details

Age: NA

Gender: Male

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (PFIZER-BIONTECH))

Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: fn4071


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2022-02-04
Date of Onset
1
Number of days (onset date – vaccination date)
1
Adverse Event Description

blackout spell; tremor; fall; vagal reaction; this is a spontaneous report received from a contactable reporter(s) (physician) from the agency regulatory authority-web. regulatory number: it-minisal02-842962. a 7 year-old male patient received bnt162b2 (comirnaty), intramuscular, administration date 04feb2022 (lot number: fn4071) as dose 1, 0.2 ml single for covid-19 immunisation. the patient's relevant medical history and concomitant medications were not reported. the following information was reported: loss of consciousness (medically significant) with onset 05feb2022, outcome "recovered" (05feb2022), described as "blackout spell"; tremor (non-serious) with onset 05feb2022, outcome "recovered" (05feb2022), described as "tremor"; fall (non-serious) with onset 05feb2022, outcome "recovered" (05feb2022), described as "fall"; presyncope (non-serious) with onset 05feb2022, outcome "recovered" (05feb2022), described as "vagal reaction". therapeutic measures were taken as a result of loss of consciousness, tremor, fall, presyncope. additional information: the events lasted a few seconds. prompt recovery after administration of glucose and water. no follow-up attempts are possible. no further information is expected

Lab Data
na
List of symptoms
tremor loss of consciousness fall presyncope
Patient Died?
No
Date Died
NA
Birth defect
false
Vaccine Administered By:
Other
Vaccine Purchased By:
Unknown
Patient visit ER?
No
Patient Hospitalized?
No
Stay in hospital
No
Days in hospital
Unspecified
Permanent disability?
No
Allergies:
na
Current Illness
na