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From the 6/4/2021 release of VAERS data:

This is VAERS ID 1269700



Case Details

VAERS ID: 1269700 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-11
Onset:2021-04-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 RA / -

Administered by: School       Purchased by: ?
Symptoms: Dizziness, Heart rate, Hyperhidrosis, Hyperventilation, Loss of consciousness, Nausea
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none
Allergies:
Diagnostic Lab Data: Test Name: heart rate; Result Unstructured Data: Test Result:Unknown Results; Test Name: pulse; Result Unstructured Data: Test Result:Unknown Results
CDC Split Type: USPFIZER INC2021417194

Write-up: was sweating profusely and breathing heavy then he passed out; was sweating profusely and breathing heavy then he passed out; was sweating profusely and breathing heavy then he passed out; he started getting dizzy; felt nauseated; This is a spontaneous report from a contactable consumer (patient''s parent). A 16-years-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration, administered in Arm Right on 11Apr2021 14:30 (Lot Number: EW0150) (age at vaccination: 16-year-old) as SINGLE DOSE for covid-19 immunisation. Medical history was reported as no. No COVID prior vaccination, no COVID tested post vaccination, no Known allergies. There were no concomitant medications (no other vaccine in four weeks and no other medications in two weeks). Right after the patient was administered the vaccine, he started getting dizzy and felt nauseated, was sweating profusely and breathing heavy then he passed out. They were in the car so the nurse reclined his chair. He passed out and then woke up and then passed out (twice) -They gave him water and gum to chew and remained laying flat. After about 20 or so minutes he felt better and nurse checked his pulse and heart rate during the ordeal. The adverse events start date was reported as 11Apr2021 14:30. No treatment received for the events. The outcome of the events was recovered.


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