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

This is VAERS ID 1035614

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Case Details

VAERS ID: 1035614 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-01-28
Onset:2021-02-04
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / UNK LA / SC

Administered by: Private       Purchased by: ?
Symptoms: Epistaxis, Oral blood blister, Petechiae, Platelet count decreased
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: mvi aspirin 81 mg daily
Current Illness: none
Preexisting Conditions: Undifferentiated connective tissue disease Sjogren''s syndrome
Allergies: none
Diagnostic Lab Data: Platelet count less than 3000
CDC Split Type:

Write-up: Patient developed symptoms on 2/13/2021 with epistaxis. Then developed blood blisters in mouth and petechiae over lower extremities. Saw me on 2/16 and labs showed platelet count less than 3000.


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