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

This is VAERS ID 1474627



Case Details

VAERS ID: 1474627 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amnesia, Depressed level of consciousness, Dyskinesia, Hyperhidrosis, Posture abnormal
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (narrow), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (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
Current Illness: None described
Preexisting Conditions: none
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediately after receiving vaccine, customer appeared to slouch over and I held his head and talked to him as I was unsure if he was just joking in front of his family. He then sat up and indicated he did not remember slouching. I explained to him that his blood pressure probably just went too low and asked him to continue breathing and try to put his head between his legs. He seemed fairly alert but a few seconds later, experienced some body jerking and I asked his father to call EMS, which he did. Customer then seemed to be in a semi alert state and started sweating profusely. I continued talking to him and watched for a fall until the EMS arrived. EMS triaged him and took him from the store. EMS reported systolic blood pressure unmeasurable upon arrival and around 70 at time of taking him from location (approximate numbers)


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