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This is VAERS ID 1477780

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1477780
VAERS Form:2
Age:13.0
Sex:Female
Location:Arizona
Vaccinated:2021-07-15
Onset:2021-07-15
Submitted:0000-00-00
Entered:2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Condition aggravated, Confusional state, Dehydration, Dizziness, Feeling hot, Flushing, Hyperhidrosis, Loss of consciousness, Syncope, Tremor, Unresponsive to stimuli, Urinary incontinence, Visual impairment

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Systemic: Confusion-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Shakiness-Severe, Systemic: Visual Changes/Disturbances-Severe, Additional Details: Vaccination was administered, within 10 min patient became unresponsive and appeared to lose conciousness. upon immediate assessment no signs of anaphylaxis were present, 911 was called. pt felt very warm to the touch and lost control of bladder. mother mentioned pt had passed out 7/14 at home but no prior history of any events. no reaction to any previous vaccines. paramedics arrived and took over pt was released under care of mother with suspision of dehydration

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