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

This is VAERS ID 1421846



Case Details

VAERS ID: 1421846 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / UNK - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal distension, Fluid retention, Peripheral swelling, Renal impairment
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: DM, HTN
Allergies: Diclofenac
Diagnostic Lab Data: At the hospital kidney function was low compared to last year that was normal.
CDC Split Type:

Write-up: Swelling of the legs and bloating of stomach, fluid retention


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1421846


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