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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 1713577 |
VAERS Form: | 2 |
Age: | 12.0 |
Sex: | Female |
Location: | Virginia |
Vaccinated: | 2021-09-18 |
Onset: | 2021-09-18 |
Submitted: | 0000-00-00 |
Entered: | 2021-09-18 |
Vaccination / Manufacturer (2 vaccines) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | 301308A / 2 | RA / IM |
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. | 308433 / N/A | LA / IM |
Administered by: Pharmacy Purchased by: ??
Symptoms: Fall, Head injury, 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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: NKDA
Diagnostic Lab Data: none
CDC 'Split Type':
Write-up: Patient experienced vasovagal syncope just minutes after receiving her second Pfizer Covid-19 vaccine and the seasonal influenza vaccine together. She was standing in our vaccine waiting area and fell hitting her head on the concrete floor, but did regain consciousness immediately. Emergency services was contacted immediately and they arrived 10 to 15 minutes later. The EMT examined her and felt it was not absolutely necessary she go to the emergency room as she remained alert and responsive. We told her mother signs and symptoms of concussion to be watchful for over the next 3 to 4 days and to report to the ER if her status changes.
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