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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 2032631 |
VAERS Form: | 2 |
Age: | 11.0 |
Sex: | Female |
Location: | Florida |
Vaccinated: | 2022-01-08 |
Onset: | 2022-01-08 |
Submitted: | 0000-00-00 |
Entered: | 2022-01-13 |
Vaccination / Manufacturer (2 vaccines) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | FL0007 / 1 | LA / IM |
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR | UT7378LA / N/A | RA / IM |
Administered by: Pharmacy Purchased by: ??
Symptoms: Dizziness, Hyperhidrosis, Pallor, Syncope
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: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NKA
Diagnostic Lab Data: NA
CDC 'Split Type':
Write-up: Patient became lightheaded about 5 minutes after vaccine administration. She then started to sweat and turn white and finally fainted. After lying her on the floor she woke up almost immediately. No further complications after that
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