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From the 1/7/2022 release of VAERS data:

This is VAERS ID 630336

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Case Details

VAERS ID: 630336 (history)  
Form: Version 1.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Submitted: 2016-04-04
Entered: 2016-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Fall, Syncope, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: US2016025833

Write-up: This case was reported by a consumer via sales rep and described the occurrence of syncopal attack in a 17-year-old female patient who received BEXSERO. In January 2016, the patient received the 1st dose of BEXSERO .5 ml. In January 2016, 1 day after receiving BEXSERO, the patient experienced syncopal attack and fall. On an unknown date, the outcome of the syncopal attack and fall were unknown. It was unknown if the reporter considered the syncopal attack and fall to be related to BEXSERO. Additional details were provided as follows: The next day after vaccination, the patient experienced syncopal episodes, even falling in the bathroom and urinating on herself. The exact date of occurrence of the event was unknown, but possibly sometime in January 2016. Little information was known about prescribing physician. The patient''s initials, date of birth, vaccine batch number and expiration date were unknown. The patient called their doctor, but their doctor said it was something else. The patient did not visited the doctor or hospital.

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