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

This is VAERS ID 1371782



Case Details

VAERS ID: 1371782 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-03
Onset:2021-06-03
   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 EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Eye movement disorder, Fatigue, Hyperhidrosis, Joint hyperextension, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Ocular motility disorders (narrow), 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: Patient family stated that he has a history of passing out after vaccine administration. This was not told to the clinical staff
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 28 year old male presented for initial dose of Phizer-BioNtech at 1100 AM on 6/3/21. Pre-assessment form was filled out and reviewed with nursing student administering the vaccine. The client stated no known allergies to medications, food, venom, or environmental elements. He also stated no allergic reactions to previous vaccines. The client also stated that he had no known health issues. After administration the patient stated he was dizzy and then immediately became unresponsive, diaphoretic, eyes rolled back, and head hyperextended. Family was present and we asked if he had any seizure history and his family declined. At this time the patient and family informed us that after vaccines in the past he does faint but didn''t inform staff before this vaccine was administered. The patient remained unresponsive for 45 seconds. Then his feet were elevated and he asked to lay down. At 11:11 AM his HR was 60 and O2 was 97% on pulse oximetry. He felt hot and was still diaphoretic and felt very fatigued. Once he started feeling better we sat him back up and his HR was 89 and O2 was 99%. We gave him 2 bottles of water and crackers. He remained in our care for 45 minutes. He then waited an additional 30 minutes in the post vaccine area. His family stated they were going to drive him home and get some food. The patient is expected to return June 24, 2021 for his second dose of the Phizer vaccine. We provided additional discharge instructions


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