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

This is VAERS ID 1470328



Case Details

VAERS ID: 1470328 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. 1659422 / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS AMVA568A / 1 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 4F99G / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: After administering vaccines patient stated he felt dizzy and started to become pale. Applied a cool compress to back of neck and laid patient down. Patient never lost consciousness. Gave him some water and notified provider. VS taken and WNL Gave him some trail mix and had him sip on water. He stated he started to feel better. Had patient wait in office for 15min and patient was able to stand up and color came back and stated he felt better.


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