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

This is VAERS ID 1375998

Case Details

VAERS ID: 1375998 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: New York  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: School       Purchased by: ?
Symptoms: Blood glucose decreased, Dyskinesia, Electrocardiogram normal, Eye movement disorder, Loss of consciousness, Seizure, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dyskinesia (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: NKDA, NKFA
Diagnostic Lab Data: Blood Glucose: 54 and second blood glucose reading was 103
CDC Split Type:

Write-up: 25 year old Male with no significant PMH presented to the vaccination clinic for his first dose of the covid-19 vaccine. Patient recieved the dose at 6PM and around 6:10pm the nurse saw the Patients eyes roll back and began to shake all four extremities "jerky movements". Patient lost consciousness for about 15-30 seconds. Once Patient regained consciousness he began to say "What happened to me?". EMS was present and PA''s. Patient reported that he had no symptoms prior to experiencing the seizure. Patient denies history of seizures, shortness of breath, chest pain, dizziness, blurry vision, abdominal pain, numbness/tingling, weakness and headache. Of note Patient has syncopized previously from blood draws. Patient was place on a 12 lead ekg: ekg unremarkable with no ST elevations, no inverted t waves, normal rate, intervals within normal intervals and no peaked t waves. Patients blood glucose was taken initially reading 54 and then Patient was given oral orange juice and the second blood glucose reading was 103. Patients initial vitals were HR: 62 RR:14, BP:117/82 with a SPO2: 100% on RA Second vital readings after 20mins there HR: 65 RR:15 BP:133/94 SPO2: 100% on RA. Patients physical exam revealed neurological exam within normal limits, Patient alert and oriented x4. Cranial nerves 2-12 intact, steady gait, ambulatory, normal finger to nose, no romberg, sensation intact in all fours extremities, all fours extremities reveal a strength of 5/5 and normal coordination. Patient was in no acute distress, alert and oriented. Cardiac exam: regular rate, rhythm, no rubs, murmurs, or gallops. Pulmonary: lungs clear bilaterally, no wheezing or rhonchi and airway patent. HEENT: Pupils equal round and reactive to light, EOM intact, airway patent, moist mucosa, no tongue lacerations, uvula mid-line. Patient was transported to the hospital via ambulance by Paramedic and EMT. Patients Mother was informed of what occurred at the vaccination site and was informed that her son was being transported to the hospital given Patients first seizure and no history of seizures.

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