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

This is VAERS ID 1331209



Case Details

VAERS ID: 1331209 (history)  
Form: Version 2.0  
Age: 15.0  
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 EW0162 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Bradycardia, Dizziness, Hypotension, Nausea, Pallor, Presyncope, Vital signs measurement
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Vasovagal reaction of c/o dizziness with nausea. bradycardia, hypotension. color pallor. Vital signs- 126/66 P-51 R-20 Temp 98.3 reaction subsided within 30 minutes. intervention required observation of s/s


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1331209


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