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

This is VAERS ID 1378019



Case Details

VAERS ID: 1378019 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Arizona  
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: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Fatigue, Pallor, Passive smoking
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was a 15 yo female. She came with her mother to get the 1st Pfizer vaccine. She was fine the vaccination room. However, after 15 minutes after the vaccine, she started to having a shortness of breath. Her face started to turn pale, she ended up passing out for 2 second which also led to 2-3 seconds of seizure. Two minutes after the event, she still look tired, mother ask to call 911. Paramedic came and check on patient as well as conducting a series of questions. After roughly 15 minutes, paramedic left and patient''s mother refused to transport to the hospital. Paramedic inform patient to check with pediatric as soon as possible. Patient looked okay and back to normal state.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1378019


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