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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1306329

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Case Details

VAERS ID: 1306329 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Florida  
Vaccinated:2021-01-26
Onset:2021-02-24
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Mental impairment, Myalgia, Pericarditis, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: QUINAPRIL; IBUPROFEN; AMLODIPINE; FOLIC ACID; METHOTREXATE
Current Illness: Arthritis rheumatoid (rheumatory arth); Blood pressure increased (high blood pressure); Seafood allergy (lobster); Seafood allergy (Crab)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: pericarditis; block-head; body aches; fever; tiredness; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of PERICARDITIS (pericarditis) in a 72-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 023M20A and 032L20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Blood pressure increased (high blood pressure) since 2000 and Arthritis rheumatoid (rheumatory arth) since 1999. Concurrent medical conditions included Seafood allergy (lobster) and Seafood allergy (Crab). Concomitant products included QUINAPRIL and AMLODIPINE for Blood pressure abnormal, IBUPROFEN and METHOTREXATE for Rheumatoid arthritis, FOLIC ACID for an unknown indication. On 26-Jan-2021 at 12:00 PM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Feb-2021 at 12:00 PM, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 24-Feb-2021, the patient experienced MENTAL IMPAIRMENT (block-head), MYALGIA (body aches), PYREXIA (fever) and FATIGUE (tiredness). On 10-Apr-2021, the patient experienced PERICARDITIS (pericarditis) (seriousness criterion hospitalization). On 25-Feb-2021, MENTAL IMPAIRMENT (block-head), MYALGIA (body aches), PYREXIA (fever) and FATIGUE (tiredness) had resolved. At the time of the report, PERICARDITIS (pericarditis) had resolved. No treatment related information has been reported. Company Comment: 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.; 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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