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

This is VAERS ID 1373140

Case Details

VAERS ID: 1373140 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Puerto Rico  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Confusional state, Disturbance in attention, Feeling abnormal, Impaired driving ability
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), 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: Minutes before I took An Arthritis Pain 640mg.
Current Illness: High pressure Osteoarthritis Gastritis Nasal allergy Lumbar pain from operation of 09/2015 Depression Anxiety Insomnia.
Preexisting Conditions: High pressure Depression Insomnia Gastritis Asthma Anxiety Osteoarthritis.
Allergies: Lobster, Aspirin.
Diagnostic Lab Data: I do not have results of anything from June 1, 2021 because I did not go to a doctor or hospital. I was driving straight home and I almost couldn''t get there.
CDC Split Type:

Write-up: Symptom that gave me in an unknown event for the first time of a dazed, confused head and difficulty concentrating and I was driving When it gave me this time after about 4 hours of the vaccine. He had not given me again since the first time September 5, 2020.

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