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

This is VAERS ID 1768663

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Case Details

VAERS ID: 1768663 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-31
Onset:2021-09-06
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test normal, Cardiac monitoring, Chest pain, Computerised tomogram normal, Dizziness, Electrocardiogram normal, Headache, Heart rate increased, Loss of consciousness, Pain
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), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: No
Preexisting Conditions: No
Allergies: Penicillin
Diagnostic Lab Data: 09/13/2021-bloodwork-Normal. CT Scan-Normal. EKG-normal. 9/14/2021-EKG-normal.
CDC Split Type: vsafe

Write-up: 09/06/2021 I passed out for ten mins. I have had several episodes of passing out since then. Still happening at random till this day. Each time I pass out something gets added to that, like dizziness, headache, pulse raises. Right arm sometimes has shooting pains. Now I am also having chest pains before passing out. 09/13/2021 passed out, taken to ER. 09/14/2021 taken to the ER again. Still passing out to the present day. On the 09/14/2021 I was give a shot called Toradol. On 10/05/2021 I was given a heart monitor to wear, till tomorrow is my last day wearing it, given to me by my doctor. I will not know the results of the heart monitor for a few weeks.


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