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From the 7/23/2021 release of VAERS data:

This is VAERS ID 1330916



Case Details

VAERS ID: 1330916 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: none
Preexisting Conditions: asthma, diabetes, high cholesterol, high blood pressure
Allergies: cephalexin, amoxicillin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: patient experienced shortness of breath about 2 minutes after giving the shot. pt also later (in maybe 10 minutes) became nauseated and dizzy


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1330916


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