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

This is VAERS ID 1330762



Case Details

VAERS ID: 1330762 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
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 EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Nausea, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: no known allergies
Diagnostic Lab Data: EMTs arrived and took patient to hospital for evaluation, it is unknown at this time.
CDC Split Type:

Write-up: Patient experienced syncope shortly after receiving vaccine while standing. Patient fell and remained on ground per advice of EMTs who arrived and escorted via ambulance for evaluation due to the patient experiencing nausea and vomiting upon rising back up.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1330762


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