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

This is VAERS ID 1454513



Case Details

VAERS ID: 1454513 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: Pt fainted...I went across the register where she was... she was fully responsive the entire time. She mentioned that she did have very low blood pressure and anticipated that she might faint. She was responsive to all my questions and was fully cognitive. She laid down little bit with legs raised.. drank some water... Sat in the chair and was Ok the entire time. Spoke with her and she said she was ok.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1454513


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