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

This is VAERS ID 1454664

Case Details

VAERS ID: 1454664 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: New York  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Heart rate decreased, Pruritus
SMQs:, Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: ripiprazole Ibuprofen Armadafinil Daily Vite Vitamin C Clopidogrel Metoprolol Benzonatate Vitamin D3 Doxazosin Mesylate Dicyclomine Azelastine Ventolin Symbicort Trintellix Hydrocodone Acetaminofen Montelukast Sodium Simvastatin
Current Illness: N/A
Preexisting Conditions: Arthritis Fibromyalgia Mitral Valve Prolapse HTN Stroke IBS Narcolepsy Carpal Tunnel
Allergies: PCN Keflex Celebrex Viox Iodine Levafloxacin
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Dose administered at 1346 on July 7, 2021 into left arm. At 1401 patient complained of chest heaviness and some scratchiness. Gave patient water. At 1405 patient was encouraged to take 2 puffs of her Albuterol Inhaler. Complaints of chest tightness did not subside and patient continued to be undecided if it was related to her asthma or not. Blood pressures taken over the course of the next hour were 176/96, 188/98, and 184/98. Pulse oximetries were 97%-98%. Heart rate dropped from 80s to 70s to 60s. At 1515 a medical first response was called for the patient who was transferred to the Emergency Department for ongoing observation.

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