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

This is VAERS ID 1376304



Case Details

VAERS ID: 1376304 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Nausea, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), 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: At 14:13 voiced complaints of Nausea, lightheadedness and dizziness. Then started vomiting. Attendee was pale and clammy. Assisted to the cot after she stopped vomiting. Elevated legs, when stated that she was no longer nauseated. HR: 84 BP 120/68 RR 16 O2sat 95. 14:20 - Attendee stated she felt better, a little pale, denied any dizziness, lightheadedness or nausea. Hr 82 BP 120/68 RR 18 O2Sat 97. 14:36 -No voiced complaints- skin warm and dry. HR 69 BP 118/64 RR 20 O2Sat 98. 14:43 - Care Practitioner educated on home discharge/adverse reaction instructions and she was discharged to home with her mother.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1376304


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