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

This is VAERS ID 1440538



Case Details

VAERS ID: 1440538 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-06-28
Onset:2021-07-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Erythema, Feeling abnormal, Sensory disturbance, Skin wrinkling
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Hypersensitivity (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt reported via phone to be experiencing a burning sensation in the neck and face, redness skin appearance that covers a significant portion of her body, something she described as "weird" and unable to explain that''s happening to her elbows, and strange "wrinkles" on her body. Pt said she did not have a PCP, she was instructed to go to her nearest walk in clinic.


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