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

This is VAERS ID 1396716



Case Details

VAERS ID: 1396716 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), 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:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Patient received vaccine dose #1. 15 minutes later she fainted. She passed out for no more than 2-4 minutes with no injuries. When she awoke, it took her about 1-2 minutes to become fully coherent. There were no other adverse reactions or side effects. EMT was called and upon arriving asked her some basic questions. Turns out she had not eaten all day so they determined the fainting was for this reason and had nothing to do with the vaccine.


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