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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1378278



Case Details

VAERS ID: 1378278 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Headache, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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: Denies.
Current Illness: Denies.
Preexisting Conditions: Denies.
Allergies: NKDA, NKEA, NKFA.
Diagnostic Lab Data: N/A.
CDC Split Type:

Write-up: Pt was reported to be "anxious and nervous" about receiving her first dose of Moderna vaccine "all day" by her husband. Pt c/o feeling nauseous 10 minutes after receiving vaccine and vomiting once in restroom after completing the required 15 minute observation period at vaccine site. Pt walked back into POD to be evaluated by writer (clinical lead), pt reported a headache after vomiting, denied any blood in her vomit. Denied any dizziness, chest pain, fever, chills, difficulty breathing, rashes, itching, difficulty speaking or swallowing, abdominal pain, weakness, numbness, tingling, or diarrhea. Pt was given water and evaluated by writer (clinical lead at site, and co-leads) and observed for and additional 30 minutes while obtaining history. Pt tolerated water PO and did not vomit in the presence of writer. Vital signs were stable and pt reported feeling "better". Physical exam was unremarkable: lungs clear, no increased work of breathing or accessory muscle use noted, airway patent, no facial, lip, or tongue swelling noted, no rashes observed, and abdomen soft and non-tender. Pt was discharged home from vaccine POD after evaluation completed. No additional vomiting or new symptoms were reported by pt or husband while still on the vaccine POD premises. Instructions provided to pt were to remain hydrated with clear liquids, advance to BRAT diet as tolerated, and pt instructed to go to ER if any new symptoms arise or anything worsens. Pt and family member emphasized understanding, and all questions were answered.


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