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This is VAERS ID 2028700

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Color Schemes (Before/After):

First Appeared on 1/14/2022

VAERS ID: 2028700
VAERS Form: 2
Age: 17.0
Sex: Female
Location: Texas
Vaccinated: 2022-01-11
Onset: 2022-01-11
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer (2 vaccines) Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3198 / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. P100386147 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Loss of consciousness, Seizure

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 briefly lost consciousness and had two convulsions after which she woke back up and acted normally once again. Patient did feel light headed afterward

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