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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1395261

Case Details

VAERS ID: 1395261 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Texas  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Anxiety, Blood pressure decreased, Dizziness, Fear, Hyperhidrosis, Malaise, Pain in extremity, Paraesthesia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Attenolol, Atorvastatin, Amlodipine
Current Illness:
Preexisting Conditions: high blood pressure
Allergies: Codeine
Diagnostic Lab Data: Once I got to the hospital I was starting to feel better. The paramedic retook my blood pressure and it was normal. I then decided to go home and left the hospital before being admitted. I recently lost my job and I didn''t have any medical insurance and I am really hoping I don''t get billed for the ambulance ride. I am afraid to get the second shot because I am afraid what happened to me might happen again. I had terrible anxiety for days after the shot and my arm was in alot of pain.
CDC Split Type:

Write-up: I received the shot and 5 minutes later I wasn''t feeling well - lightheaded, tingly hands almost immediately and after that I broke out in a sweat. 10 minutes after that my stomach started to hurt and I threw up a few times. 20 or so minutes after the shot my blood pressure dropped to 65/40 and the people administering the shot made the decision to call an ambulance and I was taken to the hospital.

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