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

This is VAERS ID 1415668



Case Details

VAERS ID: 1415668 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY5456 / 1 - / -

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: GBPFIZER INC2021657675

Write-up: Fainting; This is a spontaneous report from a contactable pharmacist received from the Agency Regulatory Authority. The regulatory authority report number is GB-MHRA-WEBCOVID-202106041350201580-SAP3P, Safety Report Unique Identifier GB-MHRA-ADR 25420610. A male patient of an unspecified age received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) via an unspecified route of administration on 04Jun2021 (Lot Number: EY5456) as single dose for COVID-19 immunisation. The patient medical history was not reported. Patient had not symptoms associated with COVID-19 or had not a COVID-19 test. The patient''s concomitant medications were not reported. The patient experienced fainting on 04Jun2021. Event outcome was recovered on 04Jun2021. No follow-up attempts are possible. No further information is expected.


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