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

This is VAERS ID 1327736



Case Details

VAERS ID: 1327736 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Illinois  
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 EW0168 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Malaise, Refusal of treatment by patient, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none listed in patients profile
Current Illness: No illnesses listed on file.
Preexisting Conditions:
Allergies: No allergies listed for patient
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patients is a 13 year old girl who came into facility to receive her Pfizer vaccine. She was nervous upon receiving her vaccine and after the shot was administered she stated she feels a little warm. The vaccinating pharmacist told her to sit and wait in the sitting area for 15 minutes after receiving the vaccine. A couple minutes after her vaccine was administered the girl started not feeling well and fainted in the store and her father caught her. We immediately called 911 and checked in with the young girl. The ambulance came and did a physical exam. They offered to take her to the hospital but the patient declined. Patient left the store shortly after with her father.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1327736


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