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

This is VAERS ID 1429742



Case Details

VAERS ID: 1429742 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-20
Onset:2021-06-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Cyanosis, Loss of consciousness, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: PENICILLIN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient lost consciousness leaning against mother slowly rolling to the ground. Patient had slight convulsions for 3-5 seconds. Patient then regained consciousness after about 5 seconds looking pale with blue lips and eyes. Upon regaining consciousness patient was told to slightly elevate head and legs for increased blood flow. Upon arrival of paramedics patient had improvement in color. Patient vitals were within normal limits aside from reported hypotension per paramedics. Handed off patient to paramedics for transport to ER for further inspection at around 11:30 am.


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