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This is VAERS ID 1331209

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1331209
VAERS Form:2
Age:15.0
Sex:Female
Location:California
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 EW0162 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Bradycardia, Dizziness, Hypotension, Nausea, Pallor, Presyncope, Vital signs measurement

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Vasovagal reaction of c/o dizziness with nausea. bradycardia, hypotension. color pallor. Vital signs- 126/66 P-51 R-20 Temp 98.3 reaction subsided within 30 minutes. intervention required observation of s/s

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