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This is VAERS ID 1475419

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1475419
VAERS Form:2
Age:13.0
Sex:Female
Location:Illinois
Vaccinated:2021-07-15
Onset:2021-07-15
Submitted:0000-00-00
Entered:2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Tremor, Eye movement disorder, Immediate post-injection reaction

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: BP was assessed and was normal (July 15, 2021)
CDC 'Split Type':

Write-up: Immediately after the vaccination, patient felt faint, started shaking, and eyes rolled in the back of her head. Patient came to and EMS came to assess her,

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1475419&WAYBACKHISTORY=ON


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