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This is VAERS ID 1929158

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Color Schemes (Before/After):

First Appeared on 12/10/2021

VAERS ID: 1929158
VAERS Form: 2
Age: 11.0
Sex: Female
Location: Georgia
Vaccinated: 2021-12-07
Onset: 2021-12-07
Submitted: 0000-00-00
Entered: 2021-12-07
Vaccin­ation / Manu­facturer (2 vaccines) Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5124 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 309622 / N/A RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Loss of consciousness, Syncope, Inappropriate schedule of product administration

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 received Pediatric Pfizer dose in left deltoid. She then received Flucelvax in right deltoid. Upon receipt of 2nd vaccine, patient fainted and lost consciousness for a few seconds. She quickly woke up, had a snack, and recovered.

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