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

This is VAERS ID 1367836

Case Details

VAERS ID: 1367836 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Virginia  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Seizure
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (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? No
Previous Vaccinations:
Other Medications: Zoloft, Olanzapine, Aurovela
Current Illness:
Preexisting Conditions: Functional Neurologic Disorder, Pseudoseizures
Allergies: Amoxacillin- hives
Diagnostic Lab Data:
CDC Split Type:

Write-up: Seizure activity noted within 30 minutes of vaccination. Pt known to have functional neurologic disorder and pseudoseizures daily (sometimes back-to-back). Pt alert and orientedx4. Pt dizzy and states she did not eat lunch today. Provided with water and granola bar. Second seizure noted 20 minutes later. Pt stayed for observation for additinal 40 minutes following second seizure. Client refused transportation to hospital and clients brother came to pick her up.

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