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From the 9/3/2021 release of VAERS data:

This is VAERS ID 1440881



Case Details

VAERS ID: 1440881 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Florida  
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 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Extremity contracture, Fall, Hypotension, Seizure, Unresponsive to stimuli, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Penicillin & Sulfa antibiotics
Diagnostic Lab Data: 88 BPM (heart rate) 98% O2 saturation (measured via OTC pulse ox machine)
CDC Split Type:

Write-up: Following administration of the vaccine, the patient and his wife were seated and I requested they remain seated for 15 min after because I had recently had someone with a fear of needles collapse after their shot, at which point I had already counseled on the things to expect afterward but the patient stopped responding and slumped over. I was unsure if he was breathing as his wife was cradling his head, so I shouted for a technician to call 911. I heard a sound that I perceived to be wheezing and administered an epipen at which point the patients limbs began to contract so I then suspected it was a seizure. We lowered the patient to the ground and shortly after he became responsive. He was able to state his name and date of birth and breathing was unlabored. Pulse ox was 98 and HR was 88 BPM before EMS arrived. They examined the patient and determined it was "anxiety induced response" but also noted that the bloodpressure was "very low" which is consistent with anaphylaxis, but I did not examine the patient at that time. He was sent home afterward.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1440881


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