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

This is VAERS ID 1403232



Case Details

VAERS ID: 1403232 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-30
Onset:2021-06-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Hallucination
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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: L-THYROXIN [LEVOTHYROXINE SODIUM]
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021645035

Write-up: hallucination; This is a spontaneous report from a contactable consumer (patient). A 38-year-old male patient received bnt162b2 (COMIRNATY), dose 1 via an unspecified route of administration on 30May2021 (at the age of 38-year-old) as 1st dose, single dose for covid-19 immunization. The patient medical history was not reported. Concomitant medication included levothyroxine sodium (L-THYROXIN [LEVOTHYROXINE SODIUM]). The patient experienced hallucination two days after vaccination (01Jun2021). The outcome of the event was unknown. Information on the lot/batch number has been requested.


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