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This is VAERS ID 1376469

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1376469
VAERS Form:2
Age:16.0
Sex:Female
Location:Pennsylvania
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 EW0177 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Seizure, Visual impairment

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: Convulsion-Severe, Additional Details: Patient went into a 3 second convulsion episode within a few seconds of receiving the vaccine. She had trouble seeing for about 4 minutes afterwards. 911 was called and paramedics took her vitals, all in range. Her mom had an episode in the past (possible Family History), and she has not eaten since the night before, shot was administered at 10:30AM.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1376469&WAYBACKHISTORY=ON


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