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

This is VAERS ID 1262390



Case Details

VAERS ID: 1262390 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-04-19
Onset:2021-04-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042821-2A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Electric shock sensation, Feeling abnormal, Headache, Injection site pain, Lymph node pain, Lymphadenopathy, Nausea
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: "lightening-like" sensation in back of neck, up into back of head upon injection. 12 hours out..feeling abnormal... chills shortly thereafter, throughout the night. also nausea, headache. Next day, mental confusion, fog.. .lymph glands under arm on right side very tender, some swelling...this continued for at least 3 days.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1262390


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