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This is VAERS ID 1367787

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1367787
VAERS Form:2
Age:15.0
Sex:Female
Location:Maine
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 EW0202 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cold sweat, Dizziness, Incoherent, Pallor, Immediate post-injection reaction

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: nka
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: patient received first covid 19 shot on 6/1 immediately had a rxn of turning very pale, clamy, dizzy, and was incoherent off and on. She never fully lost consciousness however we called 911 and she was checked out by emt. Mother reported she was filling better later in the day

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1367787&WAYBACKHISTORY=ON


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