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

This is VAERS ID 1347046



Case Details

VAERS ID: 1347046 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Immediate post-injection reaction, Immunisation anxiety related reaction, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (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), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 16 yo female, experienced syncopal episode immediately after receiving first dose of pfzier covid vaccine. Loss of conciousness noted for less than 60 seconds. Once patient regained consciousness, she presented Alert and oriented x4, verbal and able to make needs known. Respiration even and unlabored. Skin pink, warm dry and intact. No c/c of allergic reaction. No loss or altered level of consciousness noted. Patients mother reports patient has a history of anxiety, especially with medical procedures, reports prior near syncopal episodes but denies actual loss of concern, denies allergies or significant past medical HX. Patient reports feeling very nervous. Mother remained with patient and provided emotional support. Patient was assisted to ground, placed supine with lower extremities elevated, past medical HX obtained from patient and physical assessment completed simultaneously. VS 137/82 HR 75 O2 97% RR 20. Encouraged patient to relax and breathe. Within 60 seconds, patient reported feeling better, although emotional. Once pt was OK, patient was assisted from sitting position and provided oral fluids. Patient denied dizziness or lightheadedness while in sitting position. Patient was then assited to standing positions and escorted to observation area, patient sat in chair while being observed for 30 mins. After observation period, pt denied any symptoms, no acute distress noted, patient went home with mother.


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