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

This is VAERS ID 1375328



Case Details

VAERS ID: 1375328 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Feeling abnormal, Panic attack
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: Customer not a patient for rite aid. He says he is on diabetic medication and anxiety medicines.
Current Illness: unknown
Preexisting Conditions: diabetic and mood
Allergies: unknown
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt experienced extreme panic attack right after vaccination. Contacted 911, and paramedics were dispatched from Delaware County Memorial Hospital. Pt alleges he "can''t breathe and don''t feel right. Never felt like this before." Epipen was really to be administered.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1375328


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