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This is VAERS ID 2411161

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Color Schemes (Before/After):

First Appeared on 8/19/2022

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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