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This is VAERS ID 1321674

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1321674
VAERS Form:2
Age:17.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-05-03
Onset:2021-05-04
Submitted:0000-00-00
Entered:2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 RA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Loss of consciousness, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine (10 mg)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Dr. performed various neurological exercises in office.
CDC 'Split Type':

Write-up: While sitting in class, suddenly passed out and vomited at the same time. Came to about 30 seconds later. No additional adverse affects after the episode.

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