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This is VAERS ID 1346628

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1346628
VAERS Form:2
Age:17.0
Sex:Female
Location:Illinois
Vaccinated:2021-05-19
Onset:2021-05-22
Submitted:0000-00-00
Entered:2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cough, Electrocardiogram, Electroencephalogram, Loss of consciousness, Syncope

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: Blisovi-Fe 24, Claritin
Current Illness: None
Preexisting Conditions: Concussion / post - concussion syndrome - just released from f/u care. Convergence insufficiency Asthenopia Atopic Dermatitis
Allergies: Zofran (Ondansetron) - Rash
Diagnostic Lab Data: ekg and eeg (pending results)
CDC 'Split Type':

Write-up: Pt was swimming and started to cough (felt swallowed water) and upon getting out of water - collapsed and lost consciousness for a few seconds

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