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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1697355



Case Details

VAERS ID: 1697355 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (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: COPD (chronic obstructive pulmonary disease) (CMS/HCC) Essential hypertension Benign prostatic hyperplasia with lower urinary tract symptoms, symptom details unspecified Obesity ED (erectile dysfunction) GERD (gastroesophageal reflux disease) Hx of colonic polyps Glaucoma Cataracts, bilateral Bunion Unspecified hearing loss Kyphosis (acquired) (postural) Pure hypercholesterolemia Abdominal aortic ectasia (CMS/HCC) History of skin cancer in adulthood Gait disorder Actinic keratoses Gastroesophageal reflux disease Closed traumatic compression fracture of thoracic vertebra (CMS/HCC) Constipation Fatty liver Post-traumatic osteoarthritis of left knee Coronary artery disease involving native coronary artery of native heart (Calcified LAD on CT) Primary osteoarthritis of right knee Non-ischemic cardiomyopathy (CMS/HCC) Essential hypertension
Allergies: Bactrim [Sulfamethoxazole W-trimethoprim]Other: Document details in comments Feldene [Piroxicam]Rash/Dermatitis FoodHives/Urticaria, Itching Neosporin [Neomycin-bacitracin-polymyxin]Rash/Dermatitis Sulfa DrugsOther: Document details in comments
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: patient complained of lightheadedness following vaccination. he was given water & crackers & monitored for an additional 10 mins. his disposition improved.


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