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

This is VAERS ID 1246182



Case Details

VAERS ID: 1246182 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-19
Onset:2021-04-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Dyspepsia, Gastrooesophageal reflux disease, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific dysfunction (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: Fatigue and headache 12 hours following vaccine. 24 years old March 23, 2021 Moderna Covid-19
Other Medications: daily vitamin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe heartburn with acid reflux - started approx. 10 hours after vaccine. Tums and Rolaids momentarily relieved. Increased in severity after eating meals. Tried Pepcid and Milanta. Temporary relief until eating another meal, then severe symptom returned. Clinic doctor prescribed omeprazole. Acid reflux and minor heartburn continue to be experienced 4 days after. Body aches - started 10 hours after vaccine. Took Tylenol every 4-6 hours to relieve symptom. Lasted until 34 hours after vaccine. Chills - started approx 11 hours after vaccine. Fever - started approx 12 hours after vaccine. lasted 6 hours. Headache - occasional and moderate, from 12 hours after vaccine to 34 hours after.


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