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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1368402

Case Details

VAERS ID: 1368402 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: New York  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Head injury, Loss of consciousness, Palpitations
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), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (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: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was administered the vaccine. After administration we stood talking to his mother who had questions. After about 2 minutes they turned to walk away and he lost consciousness and hit his head on a counter. I unfortunately did not witness him falling. He regained consciousness almost immediately and I told him he needed to stay laying down for a few minutes first. After a few minutes he said he felt fine and we moved him to a chair. Within a few minutes, he became ill again so we had him lay down again in the consultation room. He then laid there for about 15 minutes before we moved him to a chair. He stated that before he lost consciousness his heart was racing. His mother states he''s never had any problems with vaccinations in the past. After sitting for the second time he said he felt fine except where he hit his head which was a little sore. We contacted the father later that night and he said that he too had a similar episode with a needle stick a few years prior. The patient felt better later night per his father.

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