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This is VAERS ID 1366576

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1366576
VAERS Form:2
Age:15.0
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 EW0187 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Syncope

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: LOW IRON
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: After patient got her 1st dose of Pfizer Covid 19 vaccine, she was instructed to wait 15 minutes at the resting area in front of pharmacy. On her way from immunization room to the resting area, she fainted. Since her mom was holding her, she didn''t fall. She was put down on the floor and regain consciousness within a minute. 911 was called. While waiting for paramedics, Rph took her blood pressure with result of 110/71 HR 89. Patient then walked back to immunization room with mom and Rph''s help. When paramedics arrived, they took her blood and it was low. They provided IV fluid and she was taken to hospital by ambulance.

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