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

This is VAERS ID 1745720

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Case Details

VAERS ID: 1745720 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: West Virginia  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure like phenomena, Skin discolouration, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: no known allergies reported
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: While pt was sitting in waiting area about 10 minutes after vaccine, pt''s head dropped, she turned grayish, and became unresponsive. After several seconds, she lifted her head and responded to my questions and asked for cold water. I asked for someone to call 911 and an ambulance was dispatched. A technician brought her cold water. She sat for a few minutes, then expressed an urgent need to use the restroom. Her son took her to the restroom. I checked on her a moment later. She said she was doing ok. She came back to the waiting area to wait for the EMTs. The EMTs assessed her and advised her of their recommendations and her options. She was going to go home with her son as the driver. As the EMTs turned to leave, she dropped the open bottle of water, her head fell back and she became unresponsive for a short time. The EMT expressed that this looked like seizure activity. They loaded her on a gurney and headed for the emergency room.

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