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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 1959935 |
VAERS Form: | 2 |
Age: | 8.0 |
Sex: | Female |
Location: | Virginia |
Vaccinated: | 2021-12-15 |
Onset: | 2021-12-15 |
Submitted: | 0000-00-00 |
Entered: | 2021-12-17 |
Vaccination / Manufacturer (2 vaccines) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | FL0007 / UNK | LA / IM |
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. | P100386142 / 1 | RA / IM |
Administered by: Pharmacy Purchased by: ??
Symptoms: Angina pectoris, Loss of consciousness, 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 noted
Current Illness: Unknown
Preexisting Conditions: None reported
Allergies: None reported.
Diagnostic Lab Data: Unknown
CDC 'Split Type':
Write-up: After vaccination, the patient fainted in the administration room. She was only briefly unconscious, according to the immunizing, administering technician. She wanted water when she came to. She was sent to an Urgent Care facility because she said her head hurt. Both parents were present. Do not know any more.
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