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This is VAERS ID 1375087

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1375087
VAERS Form:2
Age:16.0
Sex:Female
Location:Virginia
Vaccinated:2021-06-01
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Electrocardiogram normal, Full blood count normal, Injection site haemorrhage, Loss of consciousness, Syncope, Urine analysis normal, Immediate post-injection reaction

Life Threatening? Yes
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: None
Preexisting Conditions: NONE
Allergies: NKDA
Diagnostic Lab Data: CBC with diff on 6/2/21 at the hospital - normal UA at the hospital normal except for trace of blood in urine( patient on her period) on 6/2/21 12 Lead EKG at the hospital 6/2/21- WNL
CDC 'Split Type':

Write-up: excessive bleeding immediately the needle was withdrawn. then 9 hrs later when the bandage was being removed patient fainted for 5 mins associated with LOC.

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