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From the 1/14/2022 release of VAERS data:

This is VAERS ID 903009

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Case Details

VAERS ID: 903009 (history)  
Form: Version 2.0  
Sex: Female  
Location: West Virginia  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Work       Purchased by: ?
Symptoms: Blood glucose normal, Chills, Cold sweat, Confusional state, Dizziness, Nausea, Visual impairment
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (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: Heart arrhythmia medication.
Current Illness: no
Preexisting Conditions: Heart arrhythmia
Allergies: kna
Diagnostic Lab Data: Pulse ox : 97 blood sugar tested 90 after orange juice. BP130/80 p 127
CDC Split Type:

Write-up: Patient complained of vision disturbance confusion dizziness, chills, clammy, no trouble breathing. Nausea, Patient stated she did not have any breakfast. gave patient diphenhydramine 25 mg and EMS arrived to take her to the hospital.

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