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This is VAERS ID 1430913

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1430913
VAERS Form:2
Age:12.0
Sex:Female
Location:Indiana
Vaccinated:2021-06-25
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 FA6780 / 1 LA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Fatigue, Headache, Nausea

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: Amoxil
Diagnostic Lab Data: none at this time
CDC 'Split Type':

Write-up: Per Parent, Pt started on 06/26/2021 with headache, fatigue, and nausea at approx. 10 a.m.. Parent called our office on Monday 6/28/2021 at approx. 10:54 am and said symptoms continue.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1430913&WAYBACKHISTORY=ON


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