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

This is VAERS ID 1257415



Case Details

VAERS ID: 1257415 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Injected limb mobility decreased, Pain, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, vitamin e, collagen+ c.
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data: Emergency room on 4/20/2021, day 11 after shot. Unable to move arm.
CDC Split Type:

Write-up: Severe pain, redness, warmth. Unable to move arm/ shoulder on day 4 after shot. Unable to lift, carry, raise arm above head. Increasing pain, warmth and redness continue on day 15 after shot. Continued immobility on day 15 after shot.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1257415


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