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

This is VAERS ID 1340497

Case Details

VAERS ID: 1340497 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New Jersey  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: ?
Symptoms: SARS-CoV-2 test, Seizure, Vomiting
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), COVID-19 (broad)

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: MICARDIS
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Diagnostic Lab Data: Test Date: 20210503; Test Name: covid test, Blood test; Test Result: Negative
CDC Split Type: USPFIZER INC2021549815

Write-up: seizures; Vomiting; This is a spontaneous report from a contactable consumer (patient). A 63-year-old female patient received BNT162B2(PFIZER-BIONTECH COVID-19 VACCINE), second dose via an unspecified route of administration, administered in left arm at the age of 63-year-old on 02May2021 (Lot Number: EWQ0171) as single dose for covid-19 immunisation. Medical history reported as no. There was no known allergies. Concomitant medication included telmisartan (MICARDIS) from 2021 (received within 2 weeks of vaccination). The patient previously took first dose of BNT162B2(PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration, administered in right arm on 11Apr2021 (Lot Number: ER8729) as single dose for covid-19 immunisation. The patient experienced vomiting and 3 episodes of severe seizures after 9 hours of last vaccine dose on 02May2021. The patient was taking to the hospital emergency room and ICU for treatment. The patient reported the case as non-serious. The patient didn''t receive any other vaccines within 4 weeks prior to the COVID vaccine. The was not pregnancy at time of vaccination. Prior to vaccination, the patient wasn''t diagnosed with COVID-19. Since the vaccination, the patient had been tested for COVID-19. The patient underwent lab tests and procedures which included covid test(Blood test): negative on 03May2021. Therapeutic measures were taken as a result of the events. The outcome of the events was recovered in May2021.

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