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

This is VAERS ID 1389563



Case Details

VAERS ID: 1389563 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-06-01
Onset:2021-06-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 064C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Inflammation, Injection site erythema, Injection site inflammation, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: PATIENT REPORTED PAIN AND INFLAMMATION IN HER ARM 10 DAYS AFTER 1ST SHOT OF MODERNA. SITE ON LEFT ARM WAS RED AND INFLAMMED. PATIENT REPORTED HER ARM WAS STILL VERY SORE (SCORE 4 ON 1-10 SCALE) BUT REPORTED SHE FELT HIGHER PAIN 2-3 DAYS AFTER INJECTION WAS GIVEN. PATIENT ALSO REPORTED THAT SHE HAS BEEN TAKING TYLENOL FOR THE PAIN. SHE HAS ALSO BEEN HAVING HEADACHES THAT STARTED AFTER RECEIVING THE VACCINE. SHE REPORTED THIS IS ABNORMAL FOR HER AND USUALLY DOES NOT HAVE HEADACHES. SHE HAS BEEN DRINKING LOTS OF WATER SO THE HEADACHES ARE UNRELATED TO DEHYDRATION.


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