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History of Changes from the VAERS Wayback Machine |
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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