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

This is VAERS ID 1467756



Case Details

VAERS ID: 1467756 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disturbance in attention, Dyspnoea, Loss of consciousness, Unresponsive to stimuli
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), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: none known
Preexisting Conditions: none known
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: within about 30seconds to 1min after administering Pfizer covid vaccine, 12 year old patient passed out....went from talking, laughing to sagging off his chair, I grabbed him and slowly lowered him to the floor....he was having difficulty breathing, focusing , etc.....talked to him, focus him on breathing, gave him water to drink, wet cloth to forehead, face and neck...he came out of it and said he felt ok....he got up and walked to the waiting area with his mom...appeared to be fine, was talking and laughing again, when all of a sudden he was just sitting there, eyes wide open, but not aware. Another customer was there and she noticed him and immediately got him to focus, breathe, popped an ammonia inhalant, applied instant ice pack to his back and neck which brought him out of it.....asked mom and we called 911, EMT''s responded and transported Patient to the hospital to be checked.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1467756


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