Vaer Report Details
Age: 16 years old
Gender: Male
State: Ohio
- Patient Died?
- No
- Vaccine information
-
Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Type: Coronavirus 2019 vaccine
Manufacturer: PFIZER
Lot: fj6369
- Date report was received
- 2022-03-04
- Date form completed
- Date Vaccinated
- 2022-03-03
- Date of Onset
- 0
- Number of days (onset date – vaccination date)
- 0
- Adverse Event Description
-
systemic: syncope-medium, systemic: flushed / sweating-medium, systemic: hypotension-medium, additional details: syncope
- Lab Data
-
na
- List of symptoms
-
hyperhidrosis flushing syncope hypotension
- 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