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

This is VAERS ID 1485443



Case Details

VAERS ID: 1485443 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Head injury, Loss of consciousness
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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NKDA
Current Illness: None
Preexisting Conditions: NKDA
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient passed out after receiving immunization. vaccine received at (6:18 pm) Patient fell from chair hit her head on the ground 5 minutes after. I, a health care professional ran out to the patient after mom yelled she passed out. I called for a fan and Ice pack. RPH called emergency services immediately . patient was escorted to hopsital by ambulance.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1485443


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