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

This is VAERS ID 1477739



Case Details

VAERS ID: 1477739 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-11
Onset:2021-07-01
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (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: Hydrochlorothiazide, Lovastatin, Levothyroxine, Centrum multi-vitamins
Current Illness: None
Preexisting Conditions: Controlled hypertension, Controlled hypothyroidism, Controlled hypercholesterolemia
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Developed shingles on 07/12/2021. Never had shingles before. Started at skin area around T-12 and followed rib cage all the way around to midline on stomach. Doctor ordered acyclovir.


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