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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1729735

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Case Details

VAERS ID: 1729735 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3005288 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Loss of consciousness, Presyncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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? Yes
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: JPMODERNATX, INC.MOD20213

Write-up: Loss of consciousness; vasovagal reflex; This case was received via the RA (Reference number: JP-TAKEDA-2021TJP093152) on 11-Sep-2021 and was forwarded to Moderna on 22-Sep-2021. This case, reported by a physician, was received by the RA via Moderna''s adverse reaction reporting site (TASK0021675), and reported to the RA by a physician, was received via the RA (Ref, v21126553). Loss of consciousness was assessed as serious by the RA. On an unknown date, body temperature before the vaccination: 36.4 degrees Celsius. On 11-Sep-2021, at 14:12, the patient received the 1st dose of the vaccine. At 14:25, vasovagal reflex developed while the patient was sitting. The patient had giddiness and lost consciousness for about 10 seconds. Subsequently, the symptoms resolved. The outcome of loss of consciousness and vasovagal reflex was reported as resolved. Follow-up investigation will be made. Company Comment: The events developed after the administration of COVID-19 vaccine mRNA (mRNA 1273) and there is temporal relationship.; Reporter''s Comments: Not reported. The events developed after the administration of COVID-19 vaccine mRNA (mRNA 1273) and there is temporal relationship.; Sender''s Comments: This case concerns a 19-year-old, female patient with no relevant medical history, who experienced the unexpected event of Loss of consciousness. The event occurred on the same day after the first dose of mRNA-1273. The rechallenge was not applicable since only information about the first dose was disclosed. The reporter assessed the events as not related. The benefit-risk relationship of mRNA-1273 is not affected by this report. Event seriousness assessed as per Regulatory Authority reporting and retained for consistency with the RA report.


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