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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1714675

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Case Details

VAERS ID: 1714675 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Dyspnoea, Headache
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Difficult to breathing; Chills; Headache; This spontaneous case was reported by a consumer and describes the occurrence of DYSPNOEA (Difficult to breathing), CHILLS (Chills) and HEADACHE (Headache) in a 25-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 014F21A) for COVID-19 vaccination. No Medical History information was reported. On 10-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 10-Sep-2021, the patient experienced DYSPNOEA (Difficult to breathing), CHILLS (Chills) and HEADACHE (Headache). At the time of the report, DYSPNOEA (Difficult to breathing), CHILLS (Chills) and HEADACHE (Headache) outcome was unknown. No concomitant medication reported. No treatment information was provided


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