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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1377993



Case Details

VAERS ID: 1377993 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fall, Fear of injection, Feeling hot, Hypophagia, Loss of consciousness, Presyncope
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), Vestibular disorders (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 6-4-2021 15:30. Subjective: This 17 y/o male pt presented to the vaccine administration site and was administered his first dose of the Pfizer Covid-19 vaccine. Prior to receiving the vaccine the patient had made a comment in regards to not liking needles. Following vaccine administration the pt stated that he began to feel dizzy and ?then things went dark.? The patient was seated vertically in a chair and had fallen forward onto the ground. Patient care was immediately administered and the patient was moved supine with his lower extremities elevated. The patient regained consciousness immediately and asked if he had ?fainted?? The patient then stated that he was very warm and had not eaten or drank very much today. The patient attempted to then sit up rapidly from a supine position causing him to have a second vasovagal syncopal episode. The patient was placed in a supine position following this and cold packs were administered as well as vitals were taken. The patient remained A&O X4 with a GCS of 15 for the remainder of patient contact. EMS was called and the patient was then transported with consent of his legal guardian to the nearest E.D. Objective: Pt was noted to have two consecutive vasovagal syncopal episodes following his first dose of the Pfizer Covid-19 vaccine. The patient stated he had not eaten or drank very much today. Assessment, PE,VS: The patient was noted to have a small abrasion to the right side of his face secondary to his glasses striking him after he had fallen. The patient''s BP was noted to be 100/60 mmhg with a pulse of 64. The patient was A&O X4 with a GCS of 15 following his two separate syncopal episodes. HEENT: All findings normal, pt?s pupils PERRLA at 4mm. Cardiac: Normal Pulmonary: Normal, however verbal respiratory rate control was advised to the pt. Abdomen: Normal, cold compress applied. Extremities: Normal, Cold compress applied. Plan: Pt was continuously monitored and transferred to EMS care for transport to the nearest


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