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This is VAERS ID 1775838

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1775838
VAERS Form:2
Age:15.0
Sex:Female
Location:California
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 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Blood glucose, Dizziness, Syncope

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: None
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: None reported
Diagnostic Lab Data: BP monitoring and blood glucose monitor
CDC 'Split Type':

Write-up: Patient fainted after receiving COVID vaccine. Patients states feeling dizzy

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