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

This is VAERS ID 1447138



Case Details

VAERS ID: 1447138 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-22
Onset:2021-06-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphthous ulcer, Oral disorder, Oral pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

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: unknown. Only service we have given this pt is covid vaccine #1 & #2
Current Illness: none
Preexisting Conditions: none
Allergies: Penicillins, codeine
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Started developing canker sores and raw spots on oral mucosa, tongue and gums approximately three days after injection, peaking in severity 7/3/2021. Started improving yesterday and nearly cleared up by today. **In retrospect, patient recalls having a sore mouth with no visual lesions after first dose for a few days**


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