VAERS ID: 1861520

AGE: 10| SEX: F|STATE: SD (United States)

Description

Following Pfizer vaccination (during the 15 minute wait), parents of child brought her to nurse stating that she "started slurring her words, passed out, and had some seizure like movements." Patient was pale in color. Feet elevated at that time, cool cloth applied to forehead, and apple juice given. Patient reported feeling sick to her stomach. Drank about 2 ounces of apple juice. Provider, PAC was consulted and performed a full evaluation. Patient had vitals taken throughout the time of observation. Per PAC, exam was within normal limits prior and post vaccination. Instructions were provided to parents to follow up with PCP (MD) in 1 week for evaluation and to provide guidance on further vaccination. This was patient's first immunization.

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Symptoms

Pallor, Dysarthria, Loss of consciousness, Abdominal discomfort, Seizure like phenomena

Vaccines

VAX DATE: 11-11-2021| ONSET DATE: 11-11-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH FK5127 IM LA

RECVDATE:11-11-2021
RPT_DATE:
CAGE_YR:10
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:
V_ADMINBY:PVT
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:11-11-2021
BIRTH_DEFECT:U
OFC_VISIT:Y
ER_ED_VISIT:U
ALLERGIES:NKDA
V_FUNDBY:

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