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This is VAERS ID 1330762

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1330762
VAERS Form:2
Age:17.0
Sex:Female
Location:New York
Vaccinated:2021-05-19
Onset:2021-05-19
Submitted:0000-00-00
Entered:2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Fall, Nausea, Syncope, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: no known allergies
Diagnostic Lab Data: EMTs arrived and took patient to hospital for evaluation, it is unknown at this time.
CDC 'Split Type':

Write-up: Patient experienced syncope shortly after receiving vaccine while standing. Patient fell and remained on ground per advice of EMTs who arrived and escorted via ambulance for evaluation due to the patient experiencing nausea and vomiting upon rising back up.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1330762&WAYBACKHISTORY=ON


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