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

This is VAERS ID 1330595



Case Details

VAERS ID: 1330595 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: New York  
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 ER8736 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cold sweat, Malaise, Nervousness, Pallor, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: At 1:03 pm, patient went over to father shortly after being vaccinated and stated "I do not feel well." He sat down and briefly for <1 second became unresponsive. Upon arousing, he was pale in color and clammy to touch. RN (school nurse was at pt. side). Dad and pt. stated he was worked up and nervous before vaccine. Dr. also at pt. side. 1:15pm: Pt. drank 2 juice boxes and color improved to pink, and conversing without problem. Dr. suggested to pt. and father to have pt. lie down when he returns for his 2nd dose in 3 weeks.


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