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

This is VAERS ID 1331230



Case Details

VAERS ID: 1331230 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Maryland  
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 EW0186 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure decreased, Blood pressure fluctuation, Heart rate decreased, Hyperhidrosis, Loss of consciousness, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pale diaphoretic, syncope witnessed loc Possible seizure Transported by ambulance with mother at11:45am BP 67/30 P 46 14 99% at 12:00am BP 84/62 P 58 12 100%


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1331230


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