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

This is VAERS ID 1440582



Case Details

VAERS ID: 1440582 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye movement disorder, Feeling abnormal, Headache, Throat irritation, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: pt answered no on vaccine administration record and informed consent form
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: 2nd dose Pfizer shot administered at 9:37am. Pt was noticed to be really out of it near the front of the store. No previous history of allergic reactions and no issues with 1st dose. Patient said head was hurting bad and throat felt weird. Her eyes were rolling back in her head and she was in and out of responsiveness. Ice pack was given at 10:07am, EMS was called, at 10:10am bp 129/101 pulse 89, ems arrived on scene at 10:15am and took patient to the hospital.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1440582


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