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

This is VAERS ID 1389227



Case Details

VAERS ID: 1389227 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-28
Onset:2021-06-04
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Diarrhoea, Rash, Rash maculo-papular, Urticaria
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Sertraline 50mg, gemmily (OCP), B12 lozenge, probiotics
Current Illness: None
Preexisting Conditions: Neurocardiogenic syncope
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 6 days after, I developed a rash on my thighs, hands, forearms, elbows, upper arms, low back, and some on my lower interior stomach. The rash ranged from welt/hive-like to macule/papule type. The ones on my hands felt more like blisters. I had no anaphylaxis... Mild loose stool. Breathing fine. I still have the rash on my hands, elbows, and upper thighs, but it has started to go down as of today.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1389227


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