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

This is VAERS ID 1020671

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Case Details

VAERS ID: 1020671 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-02-04
Onset:2021-02-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Coagulation test normal, Ecchymosis, Epistaxis, Erythema, Haematocrit normal, Haemoglobin normal, Metabolic function test normal, Mouth haemorrhage, Petechiae, Platelet count decreased, Tongue erythema, White blood cell count normal
SMQs:, Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: None
Preexisting Conditions: Psoriasis
Allergies: Septra and erythromycin ointment
Diagnostic Lab Data: 2/9/21: platelets of 2.
CDC Split Type:

Write-up: 41 year old female received Moderna vaccine on 1/8/2021 (lot 011J20A) and 2/4/2021(lot 011 L20A) . About 2 days post vaccination noted small red spots on her tongue, arms and legs. On 6 days post vaccination she noticed a red mark on her neck and had prolonged epistaxis. She had a normal hemocue in the clinic and normal vital signs with no further bleeding. She was sent to the Emergency Department via chartered flight. In the ED she was noted to have a petechial rash of mucous membranes, upper and lower extremities and multiple ecchymosis. Her platelet count was 2. Hemoglobin 13.3, hematocrit 40.2%, WBC 7.86. Metabolic panel unremarkable, coagulation studies unremarkable. Vital signs normal. After consultation with hematology, Dr., she was given high dose steroids and tranexamic acid and sent via medevac to MC for possible IV Ig and platelet transfusion. She arrived there sometime early this morning. Platelets were 4 upon arrival at Medical Center.


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