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From the 7/23/2021 release of VAERS data:

This is VAERS ID 1310770



Case Details

VAERS ID: 1310770 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EW0167 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hyperhidrosis, Pallor, Presyncope
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: At clinic for first pfizer dose became pale and diaphoretic vaso vagel . Assisted to stretcher Legs elevated. Ice pack applied Seen by Dr . BP 102/60 Observed x 30 min then d/ c home with parents.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1310770


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