Received Nov 24, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| COVID19 | COVID19 (COVID19 (PFIZER-BIONTECH)) | PFIZER\BIONTECH | N/A | NA4459 | IM / LA |
Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: EYES ROLLED BACK, JERKY BODY MOVEMENTS (SIMILAR TO SEIZURE SXS)-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Confusion-Mild, Additional Details: PATIENT CONFIRMED HX OF FAINTING. PATIENT BRIEFLY LOST CONSCIOUSNESS FOLLOWING ADMINISTRATION OF 2ND VACCINE, WHILE SEATED. PATIENT AND PT'S FATHER DENIED EVALUATION/TREATMENT FROM PARAMEDICS. AFTER SEVERAL MINUTES, PATIENT WAS ABLE TO STAND UP AND WALK INDEPENDENTLY. , Other Vaccines: VaccineTypeBrand: FLUCELVAX; Manufacturer: SEQIRUS, INC; LotNumber: 948410; Route: IM; BodySite: LEFT ARM; Dose: ; VaxDate: UNKNOWN