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

This is VAERS ID 1408640



Case Details

VAERS ID: 1408640 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Face injury, Facial pain, Fall, Head injury, Lip injury, Lip swelling, Loss of consciousness, Pain in extremity, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Glaucoma (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC2021649475

Write-up: Fainting; Loss of consciousness; regained consciousness; cut his bottom lip; feeling dizzy; fell flat on his face; The patient sustained injuries to his face; cut his bottom lip; The patient sustained injuries to his face; cut his bottom lip; The patient sustained injuries to his face; cut his bottom lip; pain to the left side of his face and his left hand; The patient sustained injuries to his face; cut his bottom lip; This is a spontaneous report from a contactable pharmacist received from the Regulatory Agency. The regulatory authority report number is GB-MHRA-WEBCOVID-202106021529593550-SD5GR, Safety Report Unique Identifier GB-MHRA-ADR 25406462. A 32-years-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration on 01Jun2021 (Batch/Lot number was not reported) as 1st dose, single for covid-19 immunization. The patient medical history and concomitant medications were not reported. Patient has not had symptoms associated with COVID-19. Not had a COVID-19 test. Patient is not enrolled in clinical trial. Patient has not tested positive for COVID-19 since having the vaccine. The patient experienced fainting on 01Jun2021 with outcome of recovered, loss of consciousness on 01Jun2021 with outcome of recovered, regained consciousness (cold sweat) on 01Jun2021 with outcome of recovered, cut his bottom lip (lip swelling) on 01Jun2021 with outcome of recovered, feeling dizzy on 01Jun2021 with outcome of unknown, fell flat on his face on 01Jun2021 with outcome of unknown, the patient sustained injuries to his face; cut his bottom lip on 01Jun2021 with outcome of unknown, pain to the left side of his face and his left hand on 01Jun2021 with outcome of unknown. The clinical course was reported as follows: Patient had received his Pfizer vaccine and was in the waiting room. After around 10 minutes he got up to get a glass of water he lost consciousness and fell flat on his face. The patient sustained injuries to his face; cut his bottom lip, and lacerated his forehead, complained of pain to the left side of his face and his left hand. The patient regained consciousness quite quickly and was transferred to the recovery area. Complained of feeling dizzy therefore laid semi-recumbent. No follow-up attempts are possible, Information about Batch/Lot Number cannot be obtained.


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