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

This is VAERS ID 1430257



Case Details

VAERS ID: 1430257 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-24
Onset:2021-06-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site reaction, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: metformin
Current Illness: none
Preexisting Conditions: diabetes
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: patient reported getting covid arm. Patient had itchy rash and redness at injection site


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1430257


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