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

This is VAERS ID 1382041



Case Details

VAERS ID: 1382041 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Erythema, Fatigue, Hypoaesthesia, Pain, Paraesthesia, Pruritus, Pyrexia, Skin warm, Tenderness
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (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: cold a few weeks before vaccine
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Chills, fatigue. fever(100.9), bodyaches. Redness, warmth, tenderness, itching, tingling and numbness in right arm and fingers.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1382041


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