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

This is VAERS ID 1328250



Case Details

VAERS ID: 1328250 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Virginia  
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 EW0177 / 1 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (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), Cardiomyopathy (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1808-Child waiting in observation post vaccine and experienced vasovagal with syncope. Lowered to floor and feet elevated. Regained consciousness after 10 seconds. EMS on site arrived and assumed care. Child talking and able to answer questions accurately. 1812-BP 113/69 P 104 SPo2-96% 1818-113/59 P 105 S 1822-100/57 P 99 1827-103/55 P 95 1832-109/59 P 105 1838-104/58 P 102 Standing-1842-110/52 P 96 SPO2-98 Standing-1844-108/56 P 108 SPO2-97 Mother reports child played basketball outdoors for 1.5 hours prior to arriving at clinic. Ate a popsicle since lunchtime. Child departed EMS observation and care at 1848.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1328250


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