Report #2869217

Received Oct 28, 2025

ER / ED visit

A note on interpretation. VAERS reports are unverified and may be incomplete or coincidental. A report does not establish that a vaccine caused an event, and counts should not be used to calculate incidence or infer causation. Full disclaimer

Overview

Sex: Male
Age: 25 yrs
State: WI
Recovered: Unknown
Vaccinated: Oct 17, 2025
Onset: Oct 17, 2025
Days to onset: 0
Hospital days: —

Vaccines (3)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (PFIZER-BIONTECH))	PFIZER\BIONTECH	UNK	MY9548	IM / RA
FLU3	INFLUENZA (SEASONAL) (FLUBLOK)	SANOFI PASTEUR	UNK	TFAA2546	IM / LA
TDAP	TDAP (BOOSTRIX)	GLAXOSMITHKLINE BIOLOGICALS	UNK	292H2	IM / LA

Symptoms (6)

Eye movement disorderFallHead injuryHyperhidrosisMuscle twitchingPallor

Symptom narrative

Pt received 3 vaccines and remained seated while family members received their vaccines. Within 5 minutes post-vaccination, patient fell forward onto the floor, hitting his forehead. Patient was helped back into the chair where he remained conscious and alert but sweating profusely and because very pale. Patient's body twitched and his eyes rolled to the back of his head. EMS was called, responded, and transported patient to the hospital for further examination.

Current illness

None

Medical history

None

Other medications

None

Allergies

None