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This is VAERS ID 1096709

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1096709
VAERS Form:2
Age:17.0
Sex:Female
Location:Unknown
Vaccinated:2021-03-11
Onset:2021-03-12
Submitted:0000-00-00
Entered:2021-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Military      Purchased by: ??
Symptoms: Blood calcium normal, Blood chloride normal, Blood creatinine normal, Blood glucose increased, Blood lactic acid, Blood potassium normal, Blood sodium normal, Blood urea normal, C-reactive protein increased, Carbon dioxide normal, Generalised tonic-clonic seizure, Haematocrit normal, Haemoglobin normal, Platelet count normal, Pyrexia, White blood cell count increased, Basophil percentage decreased, Eosinophil percentage decreased, Neutrophil percentage increased, Lymphocyte percentage decreased, Monocyte percentage, Respiratory viral panel, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Briviact 10 mg/mL solution, 7 mL (70 mg) PO twice a day Miralax 1 capful daily PRN
Current Illness:
Preexisting Conditions: - Seizure disorder (no seizures since hippocampal ablation in Nov 2020) - Cortical dysplasia - Monosomy Xq26 and Trisomy 6p21.3 - Autism - Global developmental delay - Overactive bladder - Asthma
Allergies: Unasyn ? severe urticaria - Oxcarbazepine 300 mg (Trileptal) ? skin rash, fever, leukopenia, elevated liver labs - *Clobazam ? skin rash, angioedema
Diagnostic Lab Data: BMP: Na 139, K 3.6, Cl 104, CO2 23 BUN 12, Cr 0.66, Glu 124, Ca 9.0 Lacate 1.0 CBC: WBC 14.8, Hgb 13.9, Hct 40.1, Plt 342. 90.5% neutrophils, 4.5% lymphocytes, 4.7% monocytes, 0% eosinophils, 0.3% basophils, no bands ASAP SARS-CoV-2 Rapid: No pathogen detected RVP negative CRP 26.3
CDC 'Split Type':

Write-up: Fever of 103 F, received Tylenol, then developed tonic-clonic seizure activity for about 20 minutes (received 10mg intranasal midazolam and 0.5mg buccal clonazepam while awaiting EMS)


Changed on 5/7/2021

VAERS ID: 1096709 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Unknown
Vaccinated:2021-03-11
Onset:2021-03-12
Submitted:0000-00-00
Entered:2021-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Military      Purchased by: ??
Symptoms: Blood calcium normal, Blood chloride normal, Blood creatinine normal, Blood glucose increased, Blood lactic acid, Blood potassium normal, Blood sodium normal, Blood urea normal, C-reactive protein increased, Carbon dioxide normal, Generalised tonic-clonic seizure, Haematocrit normal, Haemoglobin normal, Platelet count normal, Pyrexia, White blood cell count increased, Basophil percentage decreased, Eosinophil percentage decreased, Neutrophil percentage increased, Lymphocyte percentage decreased, Monocyte percentage, Respiratory viral panel, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Briviact 10 mg/mL solution, 7 mL (70 mg) PO twice a day Miralax 1 capful daily PRN
Current Illness:
Preexisting Conditions: - Seizure disorder (no seizures since hippocampal ablation in Nov 2020) - Cortical dysplasia - Monosomy Xq26 and Trisomy 6p21.3 - Autism - Global developmental delay - Overactive bladder - Asthma
Allergies: Unasyn ? severe urticaria - Oxcarbazepine 300 mg (Trileptal) ? skin rash, fever, leukopenia, elevated liver labs - *Clobazam ? skin rash, angioedema angioedema
Diagnostic Lab Data: BMP: Na 139, K 3.6, Cl 104, CO2 23 BUN 12, Cr 0.66, Glu 124, Ca 9.0 Lacate 1.0 CBC: WBC 14.8, Hgb 13.9, Hct 40.1, Plt 342. 90.5% neutrophils, 4.5% lymphocytes, 4.7% monocytes, 0% eosinophils, 0.3% basophils, no bands ASAP SARS-CoV-2 Rapid: No pathogen detected RVP negative CRP 26.3
CDC 'Split Type':

Write-up: Fever of 103 F, received Tylenol, then developed tonic-clonic seizure activity for about 20 minutes (received 10mg intranasal midazolam and 0.5mg buccal clonazepam while awaiting EMS)


Changed on 5/14/2021

VAERS ID: 1096709 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Unknown
Vaccinated:2021-03-11
Onset:2021-03-12
Submitted:0000-00-00
Entered:2021-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Military      Purchased by: ??
Symptoms: Blood calcium normal, Blood chloride normal, Blood creatinine normal, Blood glucose increased, Blood lactic acid, Blood potassium normal, Blood sodium normal, Blood urea normal, C-reactive protein increased, Carbon dioxide normal, Generalised tonic-clonic seizure, Haematocrit normal, Haemoglobin normal, Platelet count normal, Pyrexia, White blood cell count increased, Basophil percentage decreased, Eosinophil percentage decreased, Neutrophil percentage increased, Lymphocyte percentage decreased, Monocyte percentage, Respiratory viral panel, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Briviact 10 mg/mL solution, 7 mL (70 mg) PO twice a day Miralax 1 capful daily PRN
Current Illness:
Preexisting Conditions: - Seizure disorder (no seizures since hippocampal ablation in Nov 2020) - Cortical dysplasia - Monosomy Xq26 and Trisomy 6p21.3 - Autism - Global developmental delay - Overactive bladder - Asthma
Allergies: Unasyn ? severe urticaria - Oxcarbazepine 300 mg (Trileptal) ? skin rash, fever, leukopenia, elevated liver labs - *Clobazam ? skin rash, angioedema angioedema
Diagnostic Lab Data: BMP: Na 139, K 3.6, Cl 104, CO2 23 BUN 12, Cr 0.66, Glu 124, Ca 9.0 Lacate 1.0 CBC: WBC 14.8, Hgb 13.9, Hct 40.1, Plt 342. 90.5% neutrophils, 4.5% lymphocytes, 4.7% monocytes, 0% eosinophils, 0.3% basophils, no bands ASAP SARS-CoV-2 Rapid: No pathogen detected RVP negative CRP 26.3
CDC 'Split Type':

Write-up: Fever of 103 F, received Tylenol, then developed tonic-clonic seizure activity for about 20 minutes (received 10mg intranasal midazolam and 0.5mg buccal clonazepam while awaiting EMS)

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