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This is VAERS ID 1347021

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1347021
VAERS Form:2
Age:16.0
Sex:Female
Location:Idaho
Vaccinated:2021-05-22
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 EW0169 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Anxiety, Cold sweat, Dizziness

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydroxyzine
Current Illness: None
Preexisting Conditions: Anxiety
Allergies: Denies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Faint, anxious, clammy Vital Signs: BP 85/60 HR 72 Resp 18 O2Sat 98 Skin Signs: Clammy Circulation: Cap refill <2sec Respiratory: Breath sound clear bilaterally Initial Treatment: Brought to triage and assisted to supine, Hx of anxiety 12:43 PM Vital Signs: BP 97/61 HR 68 Resp 16 O2Sat 98 Skin Signs: Warm and dry Circulation: Cap refill <1sec Respiratory: Breath sound clear bilaterally Vital Signs: HR 79 Resp 16 O2Sat 99 Skin Signs: Warm and dry Circulation: Cap refill <1sec Respiratory: Breath sound clear bilaterally Notes: Physician advised patient to seek further medical treatment should symptoms return or worsen. Home with parent.

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