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

This is VAERS ID 908123

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Case Details

VAERS ID: 908123 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: New York  
Vaccinated:2020-12-23
Onset:2020-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure immeasurable, Heart rate decreased, Hyperhidrosis, Nausea, Pulse abnormal, Pulse absent, Retching
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Levothyroxine, Tums
Current Illness: hx multiple vasovagal syncope
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient became diaphoretic and nauseated about 10 minutes post vaccination with Moderna Covid-19 vaccine. Patient was assisted to stretcher who he had dry heaves and stated he felt nauseated. HR was low around 38 and we were unable to determine a B/P but patient had a very weak radial pulse which at times was unable to be felt at all (due to low B/P). Decision made to transport patient to the ED for further evaluation. Patient eventually discharged from emergency department.


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