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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1365890



Case Details

VAERS ID: 1365890 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dehydration, Dysarthria, Hypotension, Resuscitation, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (narrow), Hypokalaemia (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: NOT SURE
Current Illness: NO
Preexisting Conditions: NOT SURE BECAUSE NOT OUR PATIENT AND NOT FILLED IN FORM
Allergies: NO
Diagnostic Lab Data: Patient was taken to I believe hospital but was fully responding and was given option if she wanted to go or not. Nephew was not sure but paramedics people said just to make sure they would have her admitted but cannot force them.
CDC Split Type:

Write-up: Patient was in wheel chair and was with her nephew. She was fine with her first Pfizer vaccine which was also administered by me. After getting 2nd dose she was told to wait in waiting area and we saw her nephew trying to talk to her but she was not responding so we called ED upon permission of her nephew and laid her on floor with her feet elevated . I did little CPR on her chest and wet paper towel on her forehead. She started talking before paramedics arrived. She was asking for fruits and her nephew said she might be hungry and he was going to take her grocery shopping after done with vaccine. Paramedics said her blood pressure was little low and she looked dehydrated and had little slurred speech so took her to I believe hospital. I told nephew to call us on how she was feeling later.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1365890


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