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

This is VAERS ID 631843

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Case Details

VAERS ID: 631843 (history)  
Form: Version 1.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
   Days after vaccination:9
Submitted: 2016-04-15
   Days after onset:7
Entered: 2016-04-18
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain upper, Decreased appetite, Dizziness, Electrocardiogram normal, Fatigue, Loss of consciousness, Nausea, Syncope, Urine analysis normal
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: 04/08/2016, Electrocardiogram, No finding; 04/08/2016, Urine analysis, No finding
CDC Split Type: US2016GSK049410

Write-up: This case was reported by a consumer and described the occurrence of passed out in a 17-year-old female patient who received BEXSERO. On 30th March 2016, the patient received BEXSERO. On 8th April 2016, 9 days after receiving BEXSERO, the patient experienced passed out (serious criteria GSK medically significant), nausea, dizziness and fainting. On 9th April 2016, the patient experienced appetite absent, stomach pain and tiredness. On an unknown date, the outcome of the passed out, nausea, dizziness, fainting, appetite absent, stomach pain and tiredness were unknown. It was unknown if the reporter considered the passed out, nausea, dizziness, fainting, appetite absent, stomach pain and tiredness to be related to BEXSERO. Additional details were received as follows: This case was reported by the patient''s mother. On 08 April 2016, 9 days after the vaccination, the patient experienced nausea, dizziness and passed out or fainted for two minutes. The mother took the patient to the emergency room. In emergency room, they did Electrocardiogram and urine test. No findings were observed. On 09 April 2016, the patient was still experiencing nausea, did not want to eat, stomach ache and very tired. In the emergency room, the mother did not remember to tell the physicians that, the patient had received a dose of BEXSERO. When she remembered the vaccine administration, she called the nurse''s line and they advised the events were from BEXSERO. The mother of the patient wanted to know how long the side effects would continue.

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