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This is VAERS ID 1377722

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1377722
VAERS Form:2
Age:15.0
Sex:Female
Location:Washington
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Fall, Seizure, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FLUOXETINE 20 MG
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: AFTER PARAMEDICS EVALUATION SHE WENT HOME WITH HER MOM.
CDC 'Split Type':

Write-up: PATIENT FAINTED AND FELL TO THE GROUND COUPLE OF MINUTES AFTER RECEIVING HER VACCINATION. SHE HAD SEIZURES ASSOCIATED WITH SYNCOPE.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1377722&WAYBACKHISTORY=ON


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