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

This is VAERS ID 1411760



Case Details

VAERS ID: 1411760 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PAA165994/EX653 / 1 LA / -

Administered by: Other       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: IEPFIZER INC2021654953

Write-up: Faint post vaccination; This is a spontaneous report from a Pfizer sponsored program. A contactable consumer (patient) reported that a 24-year-old male patient received bnt162b2 (COMIRNATY, Lot# Paa165994/EX6537), dose 1 via an unknown route of administration administered at the age of 24-year-old on arm left on 04Jun2021 14:00 as 1ST DOSE, SINGLE for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient experienced faint post vaccination on 04Jun2021 14:00 with outcome of recovered. No treatment received.


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