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From the 5/7/2021 release of VAERS data (an older release, current is 10/15/2021):

This is VAERS ID 902811



Case Details

VAERS ID: 902811 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Kansas  
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 EH9899 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fall, Seizure like phenomena
SMQs:, Convulsions (narrow), Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Associate received vaccine at 12:15 pm and was monitored for 15 minutes. After 15 minutes, associate went to check out table. While at check out table, associate fell to ground and was experiencing seizure like activity. Supportive treatment was administerd and associate was transferred to ED.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210507&IDNUMBER=902811

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