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This is VAERS ID 1775712

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1775712
VAERS Form:2
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2021-10-10
Onset:2021-10-10
Submitted:0000-00-00
Entered:2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 2 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Lethargy

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: Per mother, long time history of petite mal seizures happening many times per year since first grade.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 - 2 minutes after vaccine administration, patient appeared very faint and lethargic. Per mother, patient has a frequent history of petite mal seizures that appear in the same way. Mother moved patient to floor, elevated her legs, and we apply a cool rag to her forehead. Patient never became unresponsive or appear to have respiratory distress. After remaining on the floor for 5-10 minutes, she was able to get herself up and sit upright in a chair. She remained in the chair for approximately 10 minutes. After the initial onset of symptoms, she never worsened and only returned to normal. Before leaving, she denied any difficulty breathing, chest tightness, or itchy throat. Before leaving, she appeared in as good of health of when she initially arrived for the vaccine.

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