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

This is VAERS ID 1330585



Case Details

VAERS ID: 1330585 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Seizure, Vomiting
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations: Syncope episode
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: Pulse 106 to 94 to 86, patient drank fluids SPO2 97%(right arm) BP 104/62 Exam: Alert oriented to person, place and time HR normal sinus rhythm Vital Signs at 10:36am HR 81 regular rhythm BP 104/82 SPO2 99% (right arm)
CDC Split Type:

Write-up: An incomplete Vaers report was previously submitted for this patient. Please reference Report. Please disregard previous report. Adverse Event At 10:10am, patient was sitting with her mother when she started to convulse while sitting upright in a chair and vomited as well. This episode lasted for about 15seconds. Past medical Hx Patient reported one syncope episode after receiving a shot in the past, blood was drawn. No Hx of seizure disorder Treatment Patient was given crackers, juice, water EMS called at 10:31am for patient to have further evaluation. Patient was in stable condition prior to transport to ER A translator used, parent consent was provided.


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