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

This is VAERS ID 1474740

Case Details

VAERS ID: 1474740 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Minnesota  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Face injury, Fall, Limb injury, Lip injury, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Denied
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received her 2nd dose Pfizer COVID vaccine this afternoon at our offsite clinic by a LPN. Had just asked for a bandaid because there was a spot of blood where she had received the vaccine. Her sister reports she said she was feeling dizzy then her sister turned away and the client fell from standing position to the ground at 1412. Hit on her right side, shoulder and face. Lost conscious momentarily and together with family members we rolled her onto her back. I directed co-worker to call 911. Client came to and we helped her to sit up against the wall. Blood pressure 96/52, P 80 at 1415. Family and client denied history of seizures or fainting. Weather outside hot and client reported she hadn''t eaten anything all day. Water provided. Client reported pain from the right side of her face and her lower lip which had a laceration from the fall that was bleeding a small amount. Fire EMS arrived just after 1420. Reported their vitals as BP 110/68, P 97, O2 99%. Ambulance arrived around 1430 and assessed. They had her rise from sitting to standing and reported her SBP dropped to the 70s. Paramedics advised to be assessed in ER. Client left in ambulance at 1443 accompanied by mother. Family provided reassurance regarding syncopal episode and contributing factors. They had no further questions or concerns at time of departure.

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