National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 9/10/2021 release of VAERS data:

This is VAERS ID 1440415



Case Details

VAERS ID: 1440415 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 6/29/21: BP: 110/71 Pulse: 101
CDC Split Type:

Write-up: Pt was given shot by immunizing technician. And then sat down by her parent in the waiting area. Immunizing tech came and got me since parent was worried. Pt briefly passed out. By the time I got out into the waiting area pt had already woken up. Pt felt hot got her water and checked blood pressure and pule all within normal range. Stayed with pt who after a few minutes said was feeling better. Did not call 911 due to quick recovery. Pt was kept for observation for an additional 20 minutes. Saw further improvement and pt continued to say she feels a lot better. Told pt and mother (mother did not speak English) that they should contact primary care provider about the event and further discuss if she should receive second dose or not. Due to quick recovery, believe patient most likely was nervous and worked herself up before getting the vaccination causing her to pass out.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1440415


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166