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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1704326

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Case Details

VAERS ID: 1704326 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Condition aggravated, Injection site erythema, Injection site pain, Injection site reaction, Injection site swelling, Nausea, Pain, Pyrexia, Rash, Rash pruritic, Skin warm, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
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: Same/Similar reaction to 1st injection on 8/13/2021
Other Medications: Wellbutrin Levothyroxine Doxycycline
Current Illness: Illness from 1st Moderna Covid vaccine which was 8/13/2021
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Approx 8 hours after injection I woke with fever, chills, body aches, nausea and vomiting. I ran a fever for approx 36 hours. Pain, redness and swelling around injection site (approx 3"x3" area) also warm to the touch. An itchy rash has developed around the injection site 6 days after injection. It is also sore and warm to the touch.


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