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

This is VAERS ID 1443609



Case Details

VAERS ID: 1443609 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain lower, Diarrhoea, Headache, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinapril Setaline Glucose Senior Vitamin Omega 3 Vitamin C extended Release 65 Micrograms of iron 2x daily 2x Vitsaimin D capuls 2000 unit 2x daily Atorvastain
Current Illness:
Preexisting Conditions:
Allergies: Lisinapril Setaline Glucose Senior Vitamin Omega 3 Vitamin C extended Release 65 Micrograms of iron 2x daily 2x Vitsaimin D capuls 2000 unit 2x daily Atorvastain
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated that she received a pain in her lower abdomen. She woke up in the middle of the night with a fever and loose bowel movement. When she made it back to her bed she started vomiting. Patient also states that she had a serve headache. Patient stated that she had loose stool for five days. She could only keep down water and sports drink.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1443609


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