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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 2411161 |
VAERS Form: | 2 |
Age: | 14.0 |
Sex: | Female |
Location: | California |
Vaccinated: | 2022-08-12 |
Onset: | 2022-08-12 |
Submitted: | 0000-00-00 |
Entered: | 2022-08-15 |
Vaccination / Manufacturer (2 vaccines) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | FP7150 / 3 | LA / IM |
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. | 942379 / 1 | RA / IM |
Administered by: Pharmacy Purchased by: ??
Symptoms: Confusional state, Syncope, Tremor, Eye movement disorder
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: n/a
CDC 'Split Type':
Write-up: Eyes rolled back, shaking, fainted for 5 seconds, regained consciousness, and was confused on what happened
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