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

This is VAERS ID 1467218



Case Details

VAERS ID: 1467218 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: None given
Current Illness: None given
Preexisting Conditions: None given
Allergies: None given
Diagnostic Lab Data: Blood pressure taken 115/78 on 7/13/2021
CDC Split Type:

Write-up: Patient became dizzy, weak and woozy/nauseous. He reported that he may have passed out for a quick moment.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1467218


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