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

This is VAERS ID 1034322

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Case Details

VAERS ID: 1034322 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-04
Onset:2021-02-10
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site erythema, Injection site swelling, Petechiae, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient had similar reaction to receiving Shingrix vaccine
Other Medications: Paroxetine
Current Illness: None
Preexisting Conditions: Depression
Allergies: Iodine Mercurial derivatives Sulfa antibiotics Iodine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received first dose of Moderna Vaccine, experienced localized redness and swelling at injection site. One week post first vaccine, patient developed lower extremity petechia and rash consistent with cutaneous small vessel vasculitis. Describes itching associated with rash. Did not develop throat swell, shortness of breath, or other signs of anaphylaxis.


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