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

This is VAERS ID 1484269



Case Details

VAERS ID: 1484269 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-18
Onset:2021-07-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Dyspnoea, Hyperventilation, Injection site pain, Nervousness
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Mild, Systemic: Allergic: Difficulty Breathing-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Pt was experiencing a severe anixety attack-Mild, Systemic: Hyperventilation-Mild, Additional Details: Pt was apprehesive about the shot upon arrival to pharmacy. Very nervous. Administer the vaccine and within a few minutes patient begin to complain of lightheadness/breathing issues. I called 911 upon patient request and emts arrived within a matter of minutes. They walked patient to ambulance to check her out. Patient returned to the pharmacy after about 30 minutes to check in with us. She was feeling a little bit better and EMTs believe she had severe anxiety attack.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1484269


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