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VAERS Report 2157439

Case Report Section

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