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

This is VAERS ID 1389303



Case Details

VAERS ID: 1389303 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Flank pain, Headache, Nausea, Pain, Pyrexia, SARS-CoV-2 test, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (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: None
Preexisting Conditions: Migraines, depression
Allergies: None
Diagnostic Lab Data: PCR COVID pending, collected on 6/10/2021
CDC Split Type:

Write-up: severe headache, body aches, fever (highest 102.3), and flank pain (right) for 7d. As well as, milder nausea/vomiting. Mild cough after 6d of vaccination (#2).


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