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

This is VAERS ID 1415635



Case Details

VAERS ID: 1415635 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW3143 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Confusional state, Dizziness, Generalised tonic-clonic seizure, Loss of consciousness, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: SERTRALINE HYDROCHLORIDE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Depression mental
Allergies:
Diagnostic Lab Data: Test Name: temperature; Result Unstructured Data: Test Result:high
CDC Split Type: GBPFIZER INC2021657566

Write-up: dizzy; temperature raised very high; blacked out; feeling very confused; Seizure grand mal; This is a spontaneous report. A 37-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 03Jun2021 (Lot Number: Ew3143), at the age of 37 years, as the 1st dose, single for COVID-19 immunisation. Medical history included depression mental. Patient has not had symptoms associated with COVID-19. Not had a COVID-19 test. Patient is not enrolled in clinical trial. Concomitant medication included sertraline hydrochloride taken for depression from 24Dec2018. The patient experienced blacked out, temperature raised very high, and dizzy on an unspecified date; and seizure grand mal on 03Jun2021. Events described as follows: felt dizzy, blacked out for 3 minutes then feeling very confused to what happened when coming back round and temperature raised very high. The events caused hospitalization and considered medically significant. The patient has recovered from seizure grand mal on 03Jun2021 and outcome of the remaining events was unknown. No follow-up attempts are possible. No further information is expected.


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