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From the 6/4/2021 release of VAERS data:

This is VAERS ID 1230964



Case Details

VAERS ID: 1230964 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New York  
Vaccinated:2021-04-11
Onset:2021-04-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Headache, Helicobacter gastritis, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Helicobacter pylori infection
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: H. Pylori; chills; nausea; headache.; fever; This spontaneous case was reported by a consumer and describes the occurrence of HELICOBACTER GASTRITIS (H. Pylori) in a 65-year-old female patient who received mRNA-1273 for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Helicobacter pylori infection. On 11-Apr-2021, the patient received second dose of mRNA-1273 (Intramuscular) 2 dosage form. On 11-Apr-2021, the patient experienced PYREXIA (fever). On an unknown date, the patient experienced HELICOBACTER GASTRITIS (H. Pylori) (seriousness criterion medically significant), CHILLS (chills), NAUSEA (nausea) and HEADACHE (headache.). At the time of the report, HELICOBACTER GASTRITIS (H. Pylori), PYREXIA (fever), CHILLS (chills), NAUSEA (nausea) and HEADACHE (headache.) outcome was unknown. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded Reporter did not allow further contact; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded


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