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

This is VAERS ID 1327559



Case Details

VAERS ID: 1327559 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye movement disorder, Hypotension, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received her covid vaccine, while waiting for 15 minutes to be observed the patient fainted. Her mom noticed her eyes rolled back and started calling for help. We called 911 . Patient was placed on the ground carefully as we awaited for EMS to arrive. The patient was breathing, but had low blood pressure when EMS arrived. EMS took the patient to the hospital.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1327559


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