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

This is VAERS ID 1454508



Case Details

VAERS ID: 1454508 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscle tightness, Refusal of treatment by patient, Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT MENTIONED FEELING TIGHTNESS IN THE BODY. PATIENT FELT THAT THE MEDICATION WAS "STUCK IN THE STOMACH". PATIENT WAS MONITORED DIRECTLY BY THE PHARMACIST FOR SIGNS AND SYMPTOMS. PT WAS OFFERED TO HAVE THE 911 CALLED BUT PATIENT REFUSED. PT WAS MONITORED UNTIL SHE FELT STABLE ENOUGH TO LEAVE.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1454508


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