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

This is VAERS ID 1370838



Case Details

VAERS ID: 1370838 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Hypotension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Dehydration (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Chills-Mild, Systemic: Dizziness / Lightheadness-Medium, Systemic: Hypotension-Mild, Additional Details: 1st Dose given at 6:05 PM, lightheaded within 5 minutes. also developed chills. BP read 115/60, 5 mins later 108/67 and sat for 30 minutes. patient had improved since then and was able to leave.


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