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

This is VAERS ID 1331046



Case Details

VAERS ID: 1331046 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
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 EW0185 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Headache
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: None reported
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: On 5/19/2021 client received her first dose of the Pfizer Covid-19 Vaccine (lot #EW0185, expiration 08/2022) at 12:42. Client was found sitting upright in her chair with her mother and appeared melancholy. Client was a 13-year-old female, alert and tracking with her eyes. Client had a chief complaint of headache at 12:48. EMT and RN responded. Client stated that she began to have a headache a few minutes after her observation had begun. This was the client''s first dose of the Pfizer vaccine. Client''s mother did not report any allergies or medical history. Assessment revealed no hives, rash, discoloration, shortness of breath or other signs of anaphylaxis. Client described a generalized headache with dizziness and stated that she had eaten breakfast this morning. Airway, breathing and circulation were intact. Client denied pain throughout the rest of her body. Vitals at 12:52 were blood pressure 122/74, pulse 84, respirations 18, O2 100% on room air, temperature 97.6*f, lung sounds clear bilaterally, and client was alert and oriented to person, place, date and time. Client''s mother consented to allowing the client to lie down for 15 extra minutes but refused to remain for the entire 30-minute additional observation. Client''s mother was instructed to seek emergency care or medical attention if condition becomes severe after leaving vaccination site. Client''s final vitals were consistent at 13:07: blood pressure 118/78, pulse 84, O2 100% and respirations 18. Client''s mother was provided with all vaccine related information and acknowledged that she already knew what signs and symptoms to look for as she was already vaccinated as well. departed facility with her mother at 13:07 with client''s mother stating "I have another appointment."


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