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

This is VAERS ID 1475442



Case Details

VAERS ID: 1475442 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Chest discomfort, Dyspnoea, Feeling hot, Pruritus, Visual impairment
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Within 1-2 minutes of receiving the vaccine, patient stated feeling hot with stomach discomfort, itchiness, heavy sensation on the chest causing a difficulty in breathing, and seeing stars.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1475442


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