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From the 9/3/2021 release of VAERS data:

This is VAERS ID 1371230



Case Details

VAERS ID: 1371230 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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: UNKNOWN
Diagnostic Lab Data: FIRST RESPONDERS TOOK BLOOD PRESSURE AND BLOOD SUGAR.
CDC Split Type:

Write-up: PATIENT HAD SYNCOPE REACTION TO RECEIVING SHOT AND APPEARED TO HAVE A SEIZURE THAT LASTED A FEW SECONDS. PATIENT CAME TO AND WAS CONSCIOUS AND COHERENT.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1371230


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