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This is VAERS ID 1708765

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/24/2021

VAERS ID: 1708765
VAERS Form:2
Age:13.0
Sex:Female
Location:Tennessee
Vaccinated:2021-09-11
Onset:2021-09-11
Submitted:0000-00-00
Entered:2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Pallor, Presyncope

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 a few moments after the administration of shot was pale and lightheaded and father was calling for help. the intern ran to help the patient and patient was laid on the ground. intern checked for a pulse and tended to the patient and i immediately ran to call 911. EMS services were here within a few minutes and assessed patient. they determined it was most likely a vaso vagal response to the shot and no other systems. patient was not transported to hospital and no further medical treatment needed. followed up with dad the next day and patient was still fine and nothing out of the ordinary.

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