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VAERS ID: 1849514

AGE: 11| SEX: F|State: MA

Description

PATIENT COMPLAINED TO PARENT THAT SHE COULDN'T HEAR ANYTHING, THAT SHE COULDN'T "FEEL HER EARS" WITHIN 5 MIN AFTER BEING VACCINATED. PT SOON AFTER BECAME UNSCONSCIOUS AND FELL ON THE FLOOR. RPH WAS CALLED TO THE SITE AT THIS TIME. PT GAINED CONSCIOUSNESS ~2-5 MIN AFTER RPH WAS PRESENT. PT THEN HAD A SEIZURE THAT LASTED ABOUT 5 MIN; PT WAS SCREAMING, ASKING MOM "TO MAKE IT STOP." SHE LATER FELT BETTER BUT WAS FEELING TIRED.

Symptoms

Deafness, Screaming, Fall, Seizure, Fatigue, Hypoaesthesia, Loss of consciousness

Vaccines

VAX DATE: 05 November 2021 | ONSET DATE: 05 November 2021 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • 1
  • IM
  • RA
  • FK5127

RECVDATE:
06 November 2021
CAGE_YR:
0
CAGE_MO:
.1
RPT_DATE:
DIED:
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:
Y
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:
Y
LAB_DATA:
EMERGENCY SERVICE CALLED AND PT WAS HOSPITALIZED.
V_ADMINBY:
PHM
OTHER_MEDS:
UNKNOWN, NOT SPECIFIED BY PARENT
CUR_ILL:
NONE REPORTED BY PARENT
HISTORY:
NONE REPORTED BY PARENT
PRIOR_VAX:
UNKOWN, PARENT DID NOT SPECIFY
SPLTTYPE:
FORM_VERS:
2
TODAYS_DATE:
06 November 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
NONE REPORTED BY PARENT
V_FUNDBY:
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