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

This is VAERS ID 1156573

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Case Details

VAERS ID: 1156573 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-30
Onset:2021-03-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: C-reactive protein increased, Computerised tomogram head normal, Feeling abnormal, Guillain-Barre syndrome, Hypoaesthesia, Hyporeflexia, Muscular weakness, Myelitis transverse, Pain, Sensory loss
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Dementia (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC), atenoloL (Tenormin), garlic, ibuprofen
Current Illness:
Preexisting Conditions: Degenerative arthropathy, hyperlipidemia, hypertension, psoriasis, psoriatic arthritis, benign essential HTN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA Patient received Moderna second dose on 3/29/21 at 8:30 am and experienced weakness in legs later that day around 3:00 pm. Presented to emergency department on 3/30/21 with complaints of generalized body aches and numbness to both legs and lower arms, feeling like legs had fallen asleep. Initial examination in ED revealed sensory deficit with final diagnosis of myelitis, acute transverse and Guillain-Barre Syndrome after administration of vaccine. On 4/1/21, continuing to experience numbness with some ascending pattern, slight decrease in reflexes.


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