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

This is VAERS ID 1378183

Case Details

VAERS ID: 1378183 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Unknown  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose normal, Electrocardiogram, Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Pt got transported by EMS to the ER but patient left er without being seen.
CDC Split Type:

Write-up: TRIAGE CALLED due to syncopal episode 1:31pm pt got administered 1st Moderna covid vaccine and immediately passed out. RN called triage immediately after at 1:31pm and doctor arrived at seen 1:32 pm. 1:33 pm EKG done NSR, BP 110/90 HR 78 (lowest was 37 HR), temp 98.3, O2 97%, Blood sugar 104. 1:38 pm 911 called Time of EMS arrival and transport pt is awake, alert, oriented. Of note, pt states she usually passes out during vaccinations.

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