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

This is VAERS ID 264204

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Case Details

VAERS ID: 264204 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Massachusetts  
   Days after vaccination:1
Submitted: 2006-09-22
   Days after onset:9
Entered: 2006-10-10
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Coma, Mental impairment, Sinus arrhythmia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Disorders of sinus node function (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lithium, Propanolol, Prozac, Seraguel, Clozapine, Ritalin, Aviane, Keflex.
Current Illness: NONE
Preexisting Conditions: Bipolar DS, ADHS, left hydronephrosis.
Diagnostic Lab Data: At ER 9/13/06 EKG sinus arrhythmia, chest X ray NL, CT head normal, CBC, U/A, Lytes and toxic screen neg NL.
CDC Split Type:

Write-up: 09/13/06 pt went to school where she developed hives at 10am. She was sent home, mom came home and found pt unresponsive and called 911. Pt seen at ER. Became responsive and talking well at ER. Exam WNL. DX''d changed mental status sent home.

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