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

This is VAERS ID 1375631



Case Details

VAERS ID: 1375631 (history)  
Form: Version 2.0  
Age: 22.0  
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 002C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Movement disorder, Muscle twitching, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: No known drug/food allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Three to five minutes following vaccine administration patient was collapsed to the ground then immediately got up and sat on the floor. When I got to him he was sweating and his arms were twitching. Even though he was alert, he was struggling to straighten his arms. I made a 911 call and then administered one dose of epipen then within a minute he thanked me for the epipen and he said he is feeling much better. Finally the paramedics came in and asked him if he still wants to go for further checkups. He agreed and left the store with the paramedics.


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