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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1750415

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Case Details

VAERS ID: 1750415 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pfizer COVID-19 vaccine was administered to patient by pharmacist on 9/30/21. Approximately 10 minutes after the vaccine, pharmacist was alerted by the patient''s co-worker that the patient was exhibiting signs of fainting. Pharmacist called emergency services according to standard operating procedures and when patient actually fainted, ammonia inhalant was used to awaken patient. An ice pack was used while emergency services arrived, and patient was released according to EMS suggestion and patient consent to decline hospital transport.


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