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From the 5/14/2021 release of VAERS data (an older release, current is 10/15/2021):

This is VAERS ID 1222221

Case Details

VAERS ID: 1222221 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Puerto Rico  
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Defaecation urgency, Dizziness, Dyskinesia, Dysphagia, Electrocardiogram, Facial paralysis, Headache, Magnetic resonance imaging, Nausea, Scan with contrast, Urinary incontinence, Vascular test
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (broad), Vestibular disorders (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension
Allergies: Penicillin
Diagnostic Lab Data: Various MRI with and without contrast. Electrocardiogram, blood test, aorta studies and physical exams. It haven''t been delivered yet, I need to request them at the hospital.
CDC Split Type:

Write-up: Strong dizziness till lose the control of the left side of my body, headache, nausea, urgency to evacuate, couldn''t control my bladder, left side of the face deformity, was unable to swallow even saliva

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