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

This is VAERS ID 1450907



Case Details

VAERS ID: 1450907 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Heart rate increased, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ergocalciferol 1.25 MG (50000 UT) Capsule 1 capsule Orally weekly
Current Illness:
Preexisting Conditions: Vitamin D deficiency
Allergies: beef, lamb, alcohol, pork, chicken
Diagnostic Lab Data: None
CDC Split Type:

Write-up: During her observation time, patient complained of a rapid heart beat, shortness of breath, she had an episode of vomiting, and a syncopal episode. She was referred to a primary care physician for further evaluation. Her condition stabilized prior to discharge.


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