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

This is VAERS ID 1470163



Case Details

VAERS ID: 1470163 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-16
Onset:2021-07-13
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Herpes zoster, Vaccination complication
SMQs:, Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patients caregiver reported via phone call that patient developed shingles after receiving his first dose of the Moderna vaccine. She also reported that after speaking with his primary care physician, she determined the outbreak to be an adverse reaction of the Moderna vaccine based on her asssessment of patients symptoms and review of his medical history


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