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This is VAERS ID 1485443

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1485443
VAERS Form:2
Age:14.0
Sex:Female
Location:Arkansas
Vaccinated:2021-07-01
Onset:2021-07-01
Submitted:0000-00-00
Entered:2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Head injury, Loss of consciousness

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NKDA
Current Illness: None
Preexisting Conditions: NKDA
Allergies: None
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Patient passed out after receiving immunization. vaccine received at (6:18 pm) Patient fell from chair hit her head on the ground 5 minutes after. I, a health care professional ran out to the patient after mom yelled she passed out. I called for a fan and Ice pack. RPH called emergency services immediately . patient was escorted to hopsital by ambulance.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1485443&WAYBACKHISTORY=ON


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