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From the 9/3/2021 release of VAERS data:

This is VAERS ID 1416095



Case Details

VAERS ID: 1416095 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
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: Nausea, Skin wound
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBMODERNATX, INC.MOD20212

Write-up: Nausea; Skin wound; Nausea aggravated; This regulatory authority case was reported by a consumer and describes the occurrence of NAUSEA (Nausea aggravated), SKIN WOUND (Skin wound) and NAUSEA (Nausea) in a 34-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) (batch no. 3002332) for COVID-19 vaccination. The patient''s past medical history included Lactation decreased. 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 NAUSEA (Nausea aggravated) (seriousness criterion disability). On 05-Jun-2021, the patient experienced SKIN WOUND (Skin wound) (seriousness criterion disability). On an unknown date, the patient experienced NAUSEA (Nausea) (seriousness criterion disability). At the time of the report, NAUSEA (Nausea aggravated) and NAUSEA (Nausea) had not resolved and SKIN WOUND (Skin wound) was resolving. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. No concomitant medications was reported. The patient had large sores in the form of herpes in and around in face, lips, nose and the problem still did not improved. It hurts extreme nausea, the patient lost 1/2 weight. 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. Very limited information regarding this events has been provided at this time. No further information is expected at this time.; 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. Very limited information regarding this events has been provided at this time. No further information is expected at this time.


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