Received May 26, 2026
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| COVID19 | COVID19 (COVID19 (PFIZER-BIONTECH)) | PFIZER\BIONTECH | UNK | nj6625 | IM / LA |
Systemic: Confusion-Mild, Systemic: Fainting / Unresponsive-Severe, Systemic: Headache-Medium, Systemic: Hyperventilation-Mild, Systemic: Shakiness-Mild, Systemic: Visual Changes/Disturbances-Severe, Systemic: Weakness-Medium, Additional Details: Patient wanted several shots for her clinicals. I went to print out her proof of vaccination & patient said she felt dizzy. She had not eaten anything that day. I went to get her a chair to sit in and put it behind her. I told patient to sit down and she felt very rigid, then started falling to the right away from me. I tried to catch her, but patient fell and she did hit her head, but I think I stopped some of the strength of the impact. 911 was called but patient refused treatment and left AMA, Other Vaccines: VaccineTypeBrand: Boostrix; Manufacturer: Glaxosmithkline; LotNumber: H3729; Route: im; BodySite: deltoid; Dose: ; VaxDate: UNKNOWN, VaccineTypeBrand: Heplisav-B; Manufacturer: Dynavax Technol; LotNumber: 947987; Route: IM; BodySite: deltoid L; Dose: ; VaxDate: UNKNOWN
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