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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1745711

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Case Details

VAERS ID: 1745711 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. 312835 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Loss of consciousness, Retching, Unresponsive to stimuli
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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: torsemide, triamcinolone, sotalol, nadolol, clopidogrel, lisinopril, rosuvastatin, jantoven, metolazone
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none allergy
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient received a Pfizer booster shot in his left arm then a fluad in his right arm He then went to stand up and put his sweater back on and he fell over onto the table then he slowly went down to the ground and he collapse maybe a foot and a half off the ground Someone shouted please help I ran out and realized he was unconscious then I said call 911 and checked him tried to get him to respond over realized he was out I performed maybe 2 sets of chest compressions I then saw he was breathing still not responsive The person on 911 was very helpful then patient started to gag he told me to roll him on his side and keep him there then ems came


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