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

This is VAERS ID 1454611



Case Details

VAERS ID: 1454611 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Colorado  
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 009D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Confusional state, Eye movement disorder, Head titubation, Heart rate increased, Panic attack, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (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:
Current Illness:
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 19 year old girl received the shot and was sitting out in front of the pharmacy. She had told me she was very anxious about getting it. Her mother screamed for us, so we rushed out and had a tech call ED. When we went out there, she was hunched over forward as her mother was holding her. She appeared to be having a seizure lasting around 10 seconds and was confused when she stopped. Her mother told us before that happened, her head fell back and her eyes were rolled back. Later, the patient told us she was just having a panic attack. The paramedics arrived and checked her out. All seemed to be fine, with the exception of a fast heartbeat as expected. They convinced her to go to the hospital to be checked out. I will follow-up with her mother this evening.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1454611


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