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

This is VAERS ID 1430346

Case Details

VAERS ID: 1430346 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Fatigue, Head injury, Pain, Presyncope
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (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: Mother reported pt experiencing vasovagal rxn after unspecifed pediatric vaccine at unspecified point in past
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine administered without issue to pt (behavior & appearance normal, engaged in conversation). Pt agreed to wait 15 min. for observation and left vaccination area for monitoring area. Shortly thereafter, RPh heard what sounded like pt falling. RPh observed pt lying supine on tile floor of monitoring area. RPh assumed occurance of vasovagal syncope and went to aid pt; however, pt seemed to immediately (<1 sec.) regain consciousness, was breathing without difficulty and was able to shift to chair under own power. Tech who had been monitoring remarked pt had opted to stand rather than sit after exiting vaccination area and that she''d "hit her head" upon falling. RPh provided ice pack while pt''s mother retrieved water bottle. Pt seemed alert and cognizant of situation (denied pain, was overheard saying to assumed male relative, "You didn''t help me."). RPh strongly encouraged pt to wait 30 min. instead of 15 min. but family left after original time; mother remarked pt had vasovagal rxn after an unspecified vaccine in past (RX had not been previously made aware). About 1.5 hours later, RPh called mother to follow-up & advise on signs/symptoms of concussion. At the time, mother said she would monitor pt. Perhaps another half hour later, mother called RX to ask for advice: pt complaint of pain (took Tylenol) and tiredness (despite getting enough sleep the previous night & not usually tired around that time). RPh recommended taking pt to ER as soon as reasonably possible (mother denied any other S/S like uneven pupils, confusion or being difficult to rouse). Mother seemed receptive to that suggestion as well as warning staff of vasovagal syncope for all future vaccinations, though she could not be reached for confirmation of action the next morning.

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