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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1513678



Case Details

VAERS ID: 1513678 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-05-19
Onset:2021-05-23
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Depressed mood, Depression, Hallucination, auditory, Intentional self-injury, Suicidal ideation
SMQs:, Suicide/self-injury (narrow), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Patient was taken to psychiatric center for evaluation on 6/16/2021. She was diagnosed with depression at that time and recommendation of prescribing anti depressants.
CDC Split Type:

Write-up: Patient reported having suicidal thoughts, hearing voices. Patient started self harming after 1st does of vaccine. After 2nd dose of vaccine the self harm got worse and she became very depressed.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1513678

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