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From the 9/3/2021 release of VAERS data:

This is VAERS ID 1467745

Case Details

VAERS ID: 1467745 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Florida  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Pharmacy       Purchased by: ?
Symptoms: Electrocardiogram normal, Fall, Feeling hot, Head injury, Loss of consciousness, Nausea, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: propanolo er capsules, methylphenidate er osm tablet
Current Illness: None known.
Preexisting Conditions: Acne, ADHD, anxiety
Allergies: No known allergies.
Diagnostic Lab Data: EMTs took EKG, heart rate, and blood pressure. All were within normal ranges.
CDC Split Type:

Write-up: Patient received vaccine at seemed ok initially. No history of adverse reaction to vaccines previously and felt ok after injection, so went to pick up prescriptions and was asked to stay in store for monitoring for 15 minutes. While checking out at counter after approximately 3 to 5 minutes, patient tensed up and passed out, falling backward and hitting her head on the floor. Patient came to within 15 to 30 seconds, but complained of being hot, slightly nauseated, and was very pale. Patient was brought back into private health room with her mother and monitored by pharmacist and RXOM, and ambulance was called. Patient showed improvement and after EMT vitals came back normal, patient declined ambulance ride but was advised by pharmacy staff to contact PCP in regards to her reaction. Patient chose to leave after a few more minutes saying she felt ok.

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