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This is VAERS ID 1430585

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1430585
VAERS Form:2
Age:12.0
Sex:Female
Location:Texas
Vaccinated:2021-06-26
Onset:2021-06-26
Submitted:0000-00-00
Entered:2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Anaphylactic shock, Dizziness, Loss of consciousness, Nasopharyngitis, Pallor, Syncope, Unresponsive to stimuli, Eye movement disorder

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: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NKDA, NA - food allergies
Diagnostic Lab Data: Epipen 0.3 MG IM left thigh (anterior) administered on 6/26/21
CDC 'Split Type':

Write-up: Within minutes after receiving 1st dose of Pfizer-BioN Tech covid Vaccine 0.3 ml IM, patient complained of dizziness and fell to the ground. Patient was very pale and cold to touch, not being responsive well. Patient was losing consciousness and having difficulty keeping her head up. Patient was moved to lie down on the floor with legs up. Cold water was offered and patient took a few sip. EMS was called. Patients eyes rolled back into her head and lost consciousness/possible anaphylactic shock and not being responsive. Epipen 0.3 MG IM administered. Patient regained consciousness. Nurse practitioner was called and vitals including BP and oxygen level was performed and found to be stable. EMS arrived in few minutes and vitals were checked again by EMS personnel and patient was transferred out to nearby ER. After 3 and 1/2 hours at the ER for observation, patient was discharged.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1430585&WAYBACKHISTORY=ON


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