VAERS ID: 1493401

AGE: 12| SEX: F|STATE: CT (United States)

Description

Systemic: Seizure-Severe, Additional Details: patient was administed covid 19 pfizer vaccine. after 3 minutes, she started to convulse. she came to after about 1 minute, but was very out of it. 911 was called and she was brought to hospital.

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Symptoms

Seizure

Vaccines

VAX DATE: 07-21-2021| ONSET DATE: 07-21-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH EW0180 IM RA

RECVDATE:07-22-2021
RPT_DATE:
CAGE_YR:12
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:
V_ADMINBY:PHM
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:07-22-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:Y
ALLERGIES:
V_FUNDBY:

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