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

This is VAERS ID 1392094



Case Details

VAERS ID: 1392094 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Nervousness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (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: Concerta
Current Illness: None reported by client.
Preexisting Conditions: ADHD
Allergies: none reported by client
Diagnostic Lab Data: None completed at site.
CDC Split Type:

Write-up: Patient received the Pfizer COVID vaccine dose 1 (lot EW0187, expiration 06/28/2021) at 1413. Patient reported to RN at 1423 that he was experiencing dizziness about 5 minutes after vaccination that lasted 2 minutes. Client denied experiencing dizziness at the time that RN responded. Vital signs taken at 1423 by EMT and were as follows: O2 99%, pulse 92, blood pressure 112/78, respirations 14. Client denied associated weakness, shortness of breath, itchiness, swelling in throat or tongue, chest pain or any other symptoms. Medical conditions include: ADHD. Per Mother, medication include: concerta daily. No reported allergies. Client reports he had eaten lunch about 2 hours prior to vaccination. Per Grandmother, client get nervous when he is goes to his medical appointments. RN advised Grandmother to inform the client''s Mother that the client''s provider should be notified. Furthermore, RN advised Grandmother of signs of when to contact 911 or go to the Emergency Room. Grandmother verbalized understanding. RN informed client and grandmother that they would be monitored 30 minutes from start of symptom reporting. At 1436, vital signs: O2 99% RA, pulse 90, respirations 14, blood pressure 116/80. At 1455 vital signs: O2 99%, pulse 89, respirations 14, blood pressure 114/80. Patient left walking with steady gait. EMT assisted client and grandmother to the car.


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