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

This is VAERS ID 1416077



Case Details

VAERS ID: 1416077 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3002332 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Muscle spasms, Musculoskeletal stiffness, SARS-CoV-2 test
SMQs:, Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (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: CLARITHROMYCIN
Current Illness: Tonsillitis
Preexisting Conditions: Comments: No relevant medical history was provided by the reporter.
Allergies:
Diagnostic Lab Data: Test Date: 20210607; Test Name: COVID-19 virus test; Test Result: Negative ; Result Unstructured Data: Negative
CDC Split Type: GBMODERNATX, INC.MOD20212

Write-up: Back muscle spasms; Back pain; Back stiffness; This regulatory authority case was reported by a consumer and describes the occurrence of MUSCLE SPASMS (Back muscle spasms), BACK PAIN (Back pain) and MUSCULOSKELETAL STIFFNESS (Back stiffness) in a 33-year-old male patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) (batch no. 3002332) for COVID-19 vaccination. No relevant medical history was provided by the reporter. Concurrent medical conditions included Tonsillitis. Concomitant products included CLARITHROMYCIN from 01-Jun-2021 to an unknown date for Tonsillitis. On 04-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 MUSCULOSKELETAL STIFFNESS (Back stiffness) (seriousness criterion medically significant). On 05-Jun-2021, the patient experienced MUSCLE SPASMS (Back muscle spasms) (seriousness criterion medically significant) and BACK PAIN (Back pain) (seriousness criterion medically significant). At the time of the report, MUSCLE SPASMS (Back muscle spasms), BACK PAIN (Back pain) and MUSCULOSKELETAL STIFFNESS (Back stiffness) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 07-Jun-2021, SARS-CoV-2 test: negative (Negative) Negative. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. Patient reported excruciating back spasms and pain. Patient had not tested positive for COVID-19 since having the vaccine. No treatment medication was reported. 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. The overall seriousness of events is based on the Regulatory Authority report.; 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. The overall seriousness of events is based on the Regulatory Authority report.


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