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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1703854

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Case Details

VAERS ID: 1703854 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Hypoaesthesia, Nausea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: FIMODERNATX, INC.MOD20213

Write-up: Nausea; Dizziness; Breathing difficult; Numbness of extremities; Pyrexia; This case was received via (Reference number: FI-FIMEA-20214222) on 08-Sep-2021 and was forwarded to Moderna on 08-Sep-2021. This regulatory authority case was reported by a consumer and describes the occurrence of NAUSEA (Nausea), DIZZINESS (Dizziness), DYSPNOEA (Breathing difficult), HYPOAESTHESIA (Numbness of extremities) and PYREXIA (Pyrexia) in a 14-year-old female patient who received mRNA-1273 (Spikevax) for COVID-19 vaccination. No Medical History information was reported. On 12-Aug-2021, the patient received dose of mRNA-1273 (Spikevax) (unknown route) 1 dosage form. On 12-Aug-2021, the patient experienced NAUSEA (Nausea) (seriousness criterion life threatening), DIZZINESS (Dizziness) (seriousness criterion life threatening), DYSPNOEA (Breathing difficult) (seriousness criterion life threatening), HYPOAESTHESIA (Numbness of extremities) (seriousness criterion life threatening) and PYREXIA (Pyrexia) (seriousness criterion life threatening). At the time of the report, NAUSEA (Nausea), DIZZINESS (Dizziness), DYSPNOEA (Breathing difficult), HYPOAESTHESIA (Numbness of extremities) and PYREXIA (Pyrexia) was resolving. The action taken with mRNA-1273 (Spikevax) (Unknown) was unknown. Concomitant product use was not provided by the reporter. Treatment information was not provided. Company Comment - Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


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