Report #2858013

Received Sep 10, 2025

HospitalizedER / ED visit

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Overview

Sex: Female
Age: 12 yrs
State: AZ
Recovered: Unknown
Vaccinated: Sep 10, 2025
Onset: Sep 10, 2025
Days to onset: 0
Hospital days: —

Vaccines (2)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	3052583	IM / RA
FLU3	INFLUENZA (SEASONAL) (FLUBLOK)	SANOFI PASTEUR	1	u8823aa	IM / RA

Symptoms (2)

SeizureTremor

Symptom narrative

1 minute after administration of vaccinations patient had a seizure with her head knocking back and legs going up shaking. seizure lasted about 30 seconds. after seizure patient was seen visibly shaking. we called paramedics to have her evaluated. she got an IV and was taken to the hospital for further diagnosis

Current illness

n/a

Medical history

n/a

Other medications

n/a

Allergies

n/a

Lab data

n/a