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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1366597



Case Details

VAERS ID: 1366597 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-29
Onset:2021-06-02
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Arthralgia, Blood test, Dry eye, Dry mouth, Dry skin, Fatigue, Immune system disorder, Myalgia, Urine analysis
SMQs:, Rhabdomyolysis/myopathy (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Corneal disorders (broad), Eosinophilic pneumonia (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (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:
Other Medications: Atenolol, Synthroid, Atorvastatin, Sertraline, Duloxetine, Buspar, Oxybutynin, Fentanyl patch
Current Illness: None
Preexisting Conditions: Degenerative disc disease, osteoarthritis, chronic pain,
Allergies: Lactose intolerant
Diagnostic Lab Data: Blood tests, urine sample
CDC Split Type:

Write-up: No taste, no smell, fatigue, dry eyes, no saliva, extra dry skin, sore joints and muscles. Immune system attacking


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1366597


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