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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 2464293 |
VAERS Form: | 2 |
Age: | 15.0 |
Sex: | Female |
Location: | Pennsylvania |
Vaccinated: | 2022-09-25 |
Onset: | 2022-09-25 |
Submitted: | 0000-00-00 |
Entered: | 2022-09-29 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19-2: COVID19 (COVID19 (PFIZER-BIONTECH BIVALENT)) / PFIZER/BIONTECH | GJ5342 / 4 | LA / IM |
Administered by: Pharmacy Purchased by: ??
Symptoms: Asthenia, Confusional state, Dizziness, Loss of consciousness, Syncope, Unresponsive to stimuli
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: patient passed out and hit the wall, but was breathing and responsive while laying on floor, NP relocated Pt to minute clinic to wait for medical response team-Mild, Systemic: Weakness-Mild, Additional Details: Pt was stable and taken by private transport to urgent/emergent care
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