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

This is VAERS ID 1475644

Case Details

VAERS ID: 1475644 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Tennessee  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Deafness, Dizziness, Hypoaesthesia, Pallor, Paraesthesia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Sexual dysfunction (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: unknown
Current Illness: no known
Preexisting Conditions: none known
Allergies: cinnamon, peanuts, tree nuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt fainted approximately 5-10 minutes after vaccine administration; pt had symptoms of light-headed, dizzy, loss of vision and hearing briefly, numbness and tingling in face and hands. Pt was very pale. Pt''s feet were elevated and given a drink. Paramedics were called and assessed patient; paramedic reported normal blood pressure but slightly pulse. Pt was released without recommendation to transport. Pt mother told to call 911 if symptoms of allergic reaction occurred such as nausea, vomiting, diarrhea, rash, hives, or swelling in face, eyes, or tongue.

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