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

This is VAERS ID 1431413



Case Details

VAERS ID: 1431413 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-06-21
Onset:2021-06-21
   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 EW0151 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Fall, Hypotension, Somnolence
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: None
CDC Split Type: 904E

Write-up: Received vaccine in clinic room. Eight minutes after receiving COVID-PFE vaccine, patient complained he was ready to go and felt drowsy. The temperature did seem warm in the clinic room, so I escorted them 30 feet to the lobby. As the patient passed through the door to the lobby, his gait, he seemed to lose his ability to remain upright and started to collapse. I was able to catch him prior to hitting the floor. He never lost consciousness, but we moved him into a clinic room to evaluate and further monitor him. His blood pressure was a little low initially at 110/50, but came up to 112/60 (closer to his normal) after five to ten minutes. His pulse was strong and regular. We gave him a cool, wet compress to the forehead, cool water to drink, and chocolate candy. He was able to answer questions appropriately. We monitored him for another 30 minutes before releasing him. His mother was present with him and is a nurse practitioner. I called the Mom on 6/22/21 (the day after the event). She (Mom) reports the patient went home, laid down for about 45 minutes, then played video games. I recommend she considers getting the second dose at either Hospital, so that a higher level of care is available if needed.


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