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

This is VAERS ID 1366338



Case Details

VAERS ID: 1366338 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
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 (MODERNA)) / MODERNA 033B21A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient just got the shot and immediately feel a weird sensation. He sat on the chair to be observed and passed out almost immediately. We rushed to him and called out for him. He opened his eyes and slowly told us that he thinks he fainted. I helped him elevated both legs on the chair and talked to him if he''s hurt or any other weird feeling. He told me he''s feeling fine again. I have him lay down with his legs elevated for another 5 minutes and helped him sit up. He was able to get up by himself and sat back on the chair. A couple minutes later, I took his blood pressure and it was 129/85 and pulse was 61.


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