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

This is VAERS ID 1404409



Case Details

VAERS ID: 1404409 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Unknown  
Location: Foreign  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cold sweat, Fatigue, Feeling abnormal, Nausea, Night sweats, Pain, SARS-CoV-2 antibody test
SMQs:, Acute pancreatitis (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (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 (unsure when symptoms stopped)
Allergies:
Diagnostic Lab Data: Test Date: 20210203; Test Name: COVID-19 virus test; Test Result: Positive ; Result Unstructured Data: Positive COVID-19 test
CDC Split Type: GBMODERNATX, INC.MOD20212

Write-up: This regulatory authority case was reported by a consumer and describes the occurrence of FEELING ABNORMAL (Spaced out), COLD SWEAT (Cold sweat), NIGHT SWEATS (Night sweat), PAIN (Ache), NAUSEA (Nausea) and FATIGUE (Tiredness) in a 37-year-old patient of an unknown gender who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Suspected COVID-19 (unsure when symptoms stopped) on 30-Jan-2021. On 03-Jun-2021, the patient received first dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 04-Jun-2021, the patient experienced COLD SWEAT (Cold sweat) (seriousness criterion medically significant), NIGHT SWEATS (Night sweat) (seriousness criterion medically significant), PAIN (Ache) (seriousness criterion medically significant), NAUSEA (Nausea) (seriousness criterion medically significant) and FATIGUE (Tiredness) (seriousness criterion medically significant). On an unknown date, the patient experienced FEELING ABNORMAL (Spaced out) (seriousness criterion medically significant). At the time of the report, FEELING ABNORMAL (Spaced out), NAUSEA (Nausea) and FATIGUE (Tiredness) was resolving and COLD SWEAT (Cold sweat), NIGHT SWEATS (Night sweat) and PAIN (Ache) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 03-Feb-2021, SARS-CoV-2 antibody test: positive (Positive) Positive COVID-19 test. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. Concomitant product use was not provided. It was reported that the patient felt tired the evening of the vaccine, had arm aches the next morning and as the day went on, patient had the flu like symptoms. Patient had full body ache, tiredness, the hot and cold sweats, the feeling of being sick. It took 2 days after the vaccine to feel ok. Patient had a feeling of spaced out now. Treatment information was unknown. Patient was not enrolled in clinical trial. Patient had not tested positive for COVID-19 since having the vaccine. Based on the current available information and temporal association between the use of the product and the start date of the events cold sweat, night sweats, pain, nausea, fatigue, and feeling abnormal, 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 cold sweat, night sweats, pain, nausea, fatigue, and feeling abnormal, a causal relationship cannot be excluded.


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