1713577

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Fall, Head injury, Syncope
VAERS_ID:
1713577
CATEGORY:
2021
RECVDATE:
17 September 2021
STATE:
VA
AGE_YRS:
12.00
CAGE_YR:
12
CAGE_MO:
SEX:
F
RPT_DATE:
SYMPTOM_TEXT:
Patient experienced vasovagal syncope just minutes after receiving her second Pfizer Covid-19 vaccine and the seasonal influenza vaccine together. She was standing in our vaccine waiting area and fell hitting her head on the concrete floor, but did regain consciousness immediately. Emergency services was contacted immediately and they arrived 10 to 15 minutes later. The EMT examined her and felt it was not absolutely necessary she go to the emergency room as she remained alert and responsive. We told her mother signs and symptoms of concussion to be watchful for over the next 3 to 4 days and to report to the ER if her status changes.
DIED:
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:
U
VAX_DATE:
17 September 2021
ONSET_DATE:
17 September 2021
NUMDAYS:
0
LAB_DATA:
none
V_ADMINBY:
PHM
V_FUNDBY:
OTHER_MEDS:
unknown
CUR_ILL:
unknown
HISTORY:
unknown
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
2
TODAYS_DATE:
17 September 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
NKDA
VAX_TYPE:
COVID19, FLUC4
VAX_MANU:
PFIZER\BIONTECH, SEQIRUS, INC.
VAX_LOT:
301308A, 308433
VAX_DOSE_SERIES:
2, N/A
VAX_ROUTE:
IM
VAX_SITE:
LA, RA
VAX_NAME:
COVID19 (COVID19 (PFIZER-BIONTECH)), INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)