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

This is VAERS ID 1474994



Case Details

VAERS ID: 1474994 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Nevada  
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 051C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Nausea, Pallor, Tinnitus
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT''S FACE LOSE COLOAR . HE WAS VERY WHITE. HE ALSO HAD COLD SWEAT. HE FELT DIZZY AND HAD RINGING IN HIS EARS HE FELT LIKE HE WANTED TO THROW UP. HIS AUNT WANTED US TO CALL AMULANCE. THE PARAMEDIC CAME . ALL THE VITALS WERE NORMAL. HIS FACE COLOR STARTED COMING BACK. PARAMEDIC ALSO CHECKED IF THERE WERE RASHES ON HIS CHEST AND ARMS. NOTHING. PARA MEDIC ASKED PT WHETHER HE WANTED TO GO HOSPITAL, HE DECLINED. HE SAT 10 MORE MINUTES FOR OBSERVATION AND HE FELT WELL ENOUGH AND LEFT.


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