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This is VAERS ID 1366558

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1366558
VAERS Form:2
Age:18.0
Sex:Female
Location:California
Vaccinated:2021-06-01
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dyspnoea, Heart rate increased, Malaise, Throat tightness, Tremor

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:
Current Illness:
Preexisting Conditions:
Allergies: Peanuts
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Approximately 10 minutes after the shot, patient reports not feeling well, rapid heart beat, shakiness, and has difficulty breathing (feels like her throating is closing up). Gave one dose of 0.3 mg Epi-Pen 15 minutes after the vaccine. Called paramedics and arrived at 5:35 pm when patient was taken to the hospital. Patient was alert when she was picked up by the paramedics.

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