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

This is VAERS ID 902790

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Case Details

VAERS ID: 902790 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2020-12-16
Onset:2020-12-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Eye movement disorder, Hyperhidrosis, Memory impairment, Pallor, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Ocular motility disorders (narrow), 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: syncopal episode as child
Other Medications: zyrtec multivitamin vitamin b12
Current Illness: 12/14/20 - seen at urgent care wanting serology tests for covid. No active symptoms of covid reported at that time. Dx covid in July 2020
Preexisting Conditions: vitamin b12 deficiency
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 11 minutes after first dose of Covid Pfizer vaccine, patient became unresponsive, pale, diaphoretic with possible seizure activity. Patient dropped all belongings, leaned to the left side, with eyes rolling back in her head. Episode lasted about a minute. Patient could not remember what had happened. Vitals were BP 110/60, HR 64, RR 22. Patient was advised to go to ED for further evaluation but she refused. Patient was given a snack and an RN stayed with her for about 20 more minutes to monitor.


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