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

This is VAERS ID 1431177



Case Details

VAERS ID: 1431177 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Confusional state, Immediate post-injection reaction, Presyncope
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Reaction: Pt received vaccine in L arm. Pt had immediate vagal response post vaccine administration. Friend supporting pt until staff assisted pt to floor. Pt placed supine, legs elevated, pulses present, airway patent/breathing and able to communicate with staff. Pt reported being confused. Vital signs at 1401: HR 69, Spo2 97% on RA. 1402 Pt placed on 6L 02 for comfort. 1405 HR 61 BP 135/75 RR 16 Spo2 94%. Overall vagal response lasting 20 seconds. 911 called at 1400. Prior to EMS arrival patient A&Ox4, able to move herself to chair position with stand by assist. Patient tolerated a couple bites of granola and a few sips of water and juice. Patient than lied upon chairs with staff supervision until EMS arrived around 1420. Patient ambulated out of clinic with EMS. No record available if patient seen anywhere after episode


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