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

This is VAERS ID 1379010



Case Details

VAERS ID: 1379010 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling abnormal, Head discomfort, Headache, Impaired work ability, Pain, Pain in extremity
SMQs:, Dementia (broad), Tendinopathies and ligament 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? No
Previous Vaccinations:
Other Medications: Vitamin zinc, potassium, K-2, magnesium, and COQ-10
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Head ace the next day could not work, had to go home. Felt like my head had a lot of pressure. Body was aching really bad and my legs were also in pain. Got home and just took a nap, but felt like if I was not all there. Head was hurting so I took Advil every 8hrs on Friday. Saturday was better and head pressure went down, but most of Saturday I was recovering


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