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

This is VAERS ID 1398613



Case Details

VAERS ID: 1398613 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-05-31
Onset:2021-06-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NOT KNOWN / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Insomnia, Pyrexia, Vertigo
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Lactation decreased (Patient has not had symptoms associated with COVID-19 Not had a COVID-19 test Patient is not enrolled in clinical trial Patient is not pregnant. Patient is not currently breastfeeding .)
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBMODERNATX, INC.MOD20212

Write-up: headache; fever; Dizziness; Vertigo; Insomnia; Fatigue; This regulatory authority case was reported by a consumer and describes the occurrence of DIZZINESS (Dizziness), VERTIGO (Vertigo), INSOMNIA (Insomnia), FATIGUE (Fatigue), HEADACHE (headache) and PYREXIA (fever) in a 40-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) (batch no. Not known) for COVID-19 vaccination. The patient''s past medical history included Lactation decreased (Patient has not had symptoms associated with COVID-19 Not had a COVID-19 test Patient is not enrolled in clinical trial Patient is not pregnant. Patient is not currently breastfeeding .). On 31-May-2021, the patient received first dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 01-Jun-2021, the patient experienced INSOMNIA (Insomnia) (seriousness criterion medically significant) and FATIGUE (Fatigue) (seriousness criterion medically significant). On 02-Jun-2021, the patient experienced VERTIGO (Vertigo) (seriousness criterion medically significant). On 03-Jun-2021, the patient experienced DIZZINESS (Dizziness) (seriousness criterion medically significant). On an unknown date, the patient experienced HEADACHE (headache) (seriousness criterion medically significant) and PYREXIA (fever) (seriousness criterion medically significant). On 02-Jun-2021, FATIGUE (Fatigue) had not resolved. At the time of the report, DIZZINESS (Dizziness), VERTIGO (Vertigo) and INSOMNIA (Insomnia) had not resolved and HEADACHE (headache) and PYREXIA (fever) outcome was unknown. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. Patient experienced headache and fever 1st day and now really unwell 6 days later with the above symptoms. Concomitant product usage was not provided. Treatment details were not provided. Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


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