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

This is VAERS ID 1437630

Case Details

VAERS ID: 1437630 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Ohio  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Public       Purchased by: ?
Symptoms: Headache, Loss of consciousness, Pain
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: 1:15PM-vaccine given and patient sent to waiting room for 15 minute waiting period. 1:25PM-patients wife alerted staff that he was "passing out". Staff assisted patient in waiting room, instructed to remain seated, patient had LOC for <10 seconds and then regained consciousness immediately after. Patient instructed to remain in the clinic until 1:50PM, provided apple juice, crackers and ice pack. 1:50PM patient left with his wife, said that a friend drove them to appointment so they would not be driving. 6/30/2021 2:00PM- call to patient for follow-up, he is feeling much better today, has slight headache and body aches but no other complaints.

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