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

This is VAERS ID 1368894

Case Details

VAERS ID: 1368894 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Unknown  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Bradycardia, Dizziness, Hyperhidrosis, Hypotension, Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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: pt states he had a similar experience 20 years ago.
Other Medications: Unknown
Current Illness: NA
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt became weak, dizzy, pale and very diaphoretic a few minutes after receiving the vaccine. When further evaluated it was found that he was hypotensive and bradycardic. His blood pressure was initially 77/42 with a pulse of 54 following the vaccine at 11:21. As patient rested and drank water he was continuously evaluated and his BP increased to 91/53 a few minutes later and then it was up to 111/40 with a pulse of 60 at 11:29. Due to his condition EMS was activated @ 11:27 and they arrived on scene at 11:36 for further evaluation and transport to a higher level of care.

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