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From the 9/3/2021 release of VAERS data:

This is VAERS ID 1366355

Case Details

VAERS ID: 1366355 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: ?
Symptoms: Crying, Dizziness, Fatigue, Feeling abnormal
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 15:05 voiced complaints of feeling tired and dizzy. Crying and scared. Her mother was in attendance. They gave her some orange juice. No tachypnea or dyspnea. Skin warm and dry. 15:10 ? Attendee stated that she "felt funny". Attendee assisted to the cot and given orange juice. 15:13 - HR: 78 BP: 120/80 O2Sat%: 99. 15:16 ?Water given 15:20 -No voiced complaints- skin warm and dry. Attempted to sit her up and she reported dizziness, so she laid back down. HR: 75 BP: 110/70 O2Sat%: 100 Temperature 98.7 15:25 ? Sat up on cot the and dangled her legs without dizziness 15:26 ? Assisted to a chair and denies feeling funny or dizzy. 15:30 - discharged to home with her parents

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