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From the 1/7/2022 release of VAERS data:

This is VAERS ID 903094

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Case Details

VAERS ID: 903094 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Wisconsin  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Feeling cold, Heart rate increased, Hypertension, Incoherent, Tinnitus
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (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: Vitamin D3, C, Zinc
Current Illness: Had COVID in the beginning of 11/2020. (Tested on 11/03 results came on 4th - positive)
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: 40 min after shot experienced dizziness, feeling like was going to pass out, not coherent, BP high, fast heart rate, light headed. Got chills, freezing cold, shivering, and later in the day my ears were ringing. Extremely fatigued.

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