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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1096709

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Case Details

VAERS ID: 1096709 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-11
Onset:2021-03-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Military       Purchased by: ?
Symptoms: Basophil percentage decreased, Blood calcium normal, Blood chloride normal, Blood creatinine normal, Blood glucose increased, Blood lactic acid, Blood potassium normal, Blood sodium normal, Blood urea normal, C-reactive protein increased, Carbon dioxide normal, Eosinophil percentage decreased, Generalised tonic-clonic seizure, Haematocrit normal, Haemoglobin normal, Lymphocyte percentage decreased, Monocyte percentage, Neutrophil percentage increased, Platelet count normal, Pyrexia, Respiratory viral panel, SARS-CoV-2 test negative, White blood cell count increased
SMQs:, Haematopoietic leukopenia (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Briviact 10 mg/mL solution, 7 mL (70 mg) PO twice a day Miralax 1 capful daily PRN
Current Illness:
Preexisting Conditions: - Seizure disorder (no seizures since hippocampal ablation in Nov 2020) - Cortical dysplasia - Monosomy Xq26 and Trisomy 6p21.3 - Autism - Global developmental delay - Overactive bladder - Asthma
Allergies: Unasyn ? severe urticaria - Oxcarbazepine 300 mg (Trileptal) ? skin rash, fever, leukopenia, elevated liver labs - *Clobazam ? skin rash, angioedema
Diagnostic Lab Data: BMP: Na 139, K 3.6, Cl 104, CO2 23 BUN 12, Cr 0.66, Glu 124, Ca 9.0 Lacate 1.0 CBC: WBC 14.8, Hgb 13.9, Hct 40.1, Plt 342. 90.5% neutrophils, 4.5% lymphocytes, 4.7% monocytes, 0% eosinophils, 0.3% basophils, no bands ASAP SARS-CoV-2 Rapid: No pathogen detected RVP negative CRP 26.3
CDC Split Type:

Write-up: Fever of 103 F, received Tylenol, then developed tonic-clonic seizure activity for about 20 minutes (received 10mg intranasal midazolam and 0.5mg buccal clonazepam while awaiting EMS)


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1096709


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