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From the 9/10/2021 release of VAERS data:

This is VAERS ID 912103



Case Details

VAERS ID: 912103 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2020-12-28
Onset:2020-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abnormal behaviour, Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Vestibular disorders (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: Cryselle 1 tab orally once daily Fluoxetine 20 mg orally once daily
Current Illness:
Preexisting Conditions: Anxiety, depression, menorrhagia, family hx of Marfan syndrome
Allergies: Amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness and nausea 10 minutes after injection, continued to wax and wane over approx 90 minutes. No vitals taken. Patient ambulated back to work at 1800.


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