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This is VAERS ID 1376417

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1376417
VAERS Form:2
Age:15.0
Sex:Female
Location:North Carolina
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Flushing, Hyperhidrosis, Pallor, Syncope, Tinnitus, Tremor, Unresponsive to stimuli

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Mild, Systemic: Shakiness-Mild, Systemic: Tinnitus-Mild, Additional Details: After vaccine administration at approximately 09:10a, per mother stood up from vaccine area to walk to post-vaccination area with complaints of feeling light headed. Pharmacist notified & went to help pt in the post vaccination area. Pt was diaphoretic, pale, and appeared as though she was going to faint. Pts mother, pharmacist, and bystander assisted patient to the ground with legs bent, water, crackers, and ice pack provided. Patient was starting to become more responsive. Paramedics called.

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