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

This is VAERS ID 1467291



Case Details

VAERS ID: 1467291 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Massachusetts  
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 050C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: N/A
CDC Split Type:

Write-up: PATIENT APPEARED VERY PALE, FELT NAUSEOUS, DIZZY, AND SWEATING. NO BREATHING PROBLEM, NO SWELLING OF LIPS OR THROAT. ACCOMPANYING FRIEND SAID PATIENT DID NOT HAVE ANY BREAKFAST BEFORE VACCINATION. PHARMACY STAFF HELP ALLEVIATE PATIENT''S LEGS AND ENSURED ADEQUATE VENTILATION.


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