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This is VAERS ID 1693694

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1693694
VAERS Form:2
Age:15.0
Sex:Female
Location:Texas
Vaccinated:2021-09-12
Onset:2021-09-12
Submitted:0000-00-00
Entered:2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Loss of consciousness

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: Patient passed out . No fall injury occurred and patient recovered from the episode immediately. Removed from vehicle to EMS to get vitals. Patient has had syncope episodes or nausea in the past after receiving a shot. Patient then returned to vehicle and was monitored by EMS for an additional 30mins.

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