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

This is VAERS ID 1404351



Case Details

VAERS ID: 1404351 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3002332 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Influenza, Influenza like illness, SARS-CoV-2 test, Vaccination site pain
SMQs:, Infective pneumonia (broad), Opportunistic infections (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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Suspected COVID-19
Allergies:
Diagnostic Lab Data: Test Date: 20201227; Test Name: COVID-19 virus test; Test Result: Positive ; Result Unstructured Data: Positive
CDC Split Type: GBMODERNATX, INC.MOD20212

Write-up: Flu like symptoms onset in the evening of 1/6 / 2021; Flu; Pain in upper left arm (vaccination site); This regulatory authority case was reported by a consumer and describes the occurrence of INFLUENZA LIKE ILLNESS (Flu like symptoms onset in the evening of 1/6 / 2021), INFLUENZA (Flu) and VACCINATION SITE PAIN (Pain in upper left arm (vaccination site)) in a 34-year-old male patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) (batch no. 3002332) for COVID-19 vaccination. The patient''s past medical history included Suspected COVID-19 from 26-Dec-2020 to 05-Jan-2021. On 01-Jun-2021 at 9:00 AM, the patient received first dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 01-Jun-2021, the patient experienced INFLUENZA LIKE ILLNESS (Flu like symptoms onset in the evening of 1/6 / 2021) (seriousness criterion medically significant), INFLUENZA (Flu) (seriousness criterion medically significant) and VACCINATION SITE PAIN (Pain in upper left arm (vaccination site)) (seriousness criterion medically significant). The patient was treated with PARACETAMOL for Flu like symptoms, at a dose of 1000 mg every four hours. At the time of the report, INFLUENZA LIKE ILLNESS (Flu like symptoms onset in the evening of 1/6 / 2021) was resolving and INFLUENZA (Flu) and VACCINATION SITE PAIN (Pain in upper left arm (vaccination site)) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 27-Dec-2020, SARS-CoV-2 test: positive (Positive) Positive. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. Concomitant medication information was not reported. Patient was not enrolled in clinical trial. Patient has not tested positive for COVID-19 since having the vaccine 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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