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This is VAERS ID 1367880

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1367880
VAERS Form:2
Age:24.0
Sex:Female
Location:Indiana
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 EW0171 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Dizziness, Syncope, 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: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NKA
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Immediately after vaccine patient stood up and became dizzy and passed out. B/P 95/61 at 6:02 had patient lay down and gave crackers and juice. B/P 101/65 at 6:39. Patient was feeling better and left with significant other

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