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

This is VAERS ID 1434917



Case Details

VAERS ID: 1434917 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Dizziness, Fall, Tachyphrenia
SMQs:, Anticholinergic syndrome (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (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? No
Previous Vaccinations: dizziness after receiving any vaccine throughout his whole life
Other Medications: Patient denies taking prescription, over-the-counter medications, dietary supplements, or herbal remedies at the time of vaccination.
Current Illness: Patient denies having other illnesses at the time of vaccination and up to one month prior.
Preexisting Conditions: Patient denies having any chronic or long-standing health conditions.
Allergies: Patient reports to have no known allergies to food, medication, or other products.
Diagnostic Lab Data: Supervisor on duty asked the patient if he would like to be taken to the hospital emergency department, but patient stated he did not need to go and said he felt fine.
CDC Split Type:

Write-up: After receiving the Moderna vaccine, the patient was sitting in a chair in the pharmacy waiting area. About 5 minutes afterwards, he fell out of his chair. Upon asking the patient if he was okay and what happened, he reported he felt dizzy with racing thoughts on his mind. Then he lost his balance, slipped out of his chair, and fell to the floor. He stated he has dizziness after every vaccine he has received in the past. He sat back in the chair and rested, and also reported he felt better. The supervisor on duty provided the patient with water. About 15 minutes after falling, the patient stated he felt fine and wanted to leave. He was stable upon standing up from the chair. I informed him if he experiences any other symptoms, that he should call my pharmacy, or if he experiences anaphylaxis, he should call 911 and seek immediate medical attention.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1434917


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