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

This is VAERS ID 1738894

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Case Details

VAERS ID: 1738894 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Headache, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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:
Other Medications: OVRANETTE; SERTRALINE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Suspected COVID-19
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBMODERNATX, INC.MOD20213

Write-up: Back pain; Headache; Nausea; Fever; This case was received via regulatory authority (Reference number: GB-MHRA-ADR 25945074) on 16-Sep-2021 and was forwarded to Moderna on 16-Sep-2021. This regulatory authority case was reported by a consumer and describes the occurrence of BACK PAIN (Back pain), HEADACHE (Headache), NAUSEA (Nausea) and PYREXIA (Fever) in a 30-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Suspected COVID-19 from 26-Dec-2019 to 03-Jan-2020. Concomitant products included ETHINYLESTRADIOL, LEVONORGESTREL (OVRANETTE) for Contraception, SERTRALINE for Depression. On 14-Sep-2021, the patient received second dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 14-Sep-2021, the patient experienced BACK PAIN (Back pain) (seriousness criterion medically significant), HEADACHE (Headache) (seriousness criterion medically significant), NAUSEA (Nausea) (seriousness criterion medically significant) and PYREXIA (Fever) (seriousness criterion medically significant). On 15-Sep-2021, PYREXIA (Fever) had resolved. At the time of the report, BACK PAIN (Back pain) and NAUSEA (Nausea) was resolving and HEADACHE (Headache) had not resolved. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. Treatment medication were not reported. Patient had not tested positive for COVID-19 since having vaccine and was not enrolled in clinical trial. Company Comment: This case concerns a 30-year-old female with a medical history of depression, who experienced the unexpected events of back pain, headache, nausea and pyrexia on the same day after the second dose of mRNA-1273 (Moderna CoviD-19 Vaccine). The rechallenge was unknown as there''s no information available about the first dose. The benefit-risk relationship of mRNA-1273 (Moderna CoviD-19 Vaccine) is not affected by this report.; Sender''s Comments: This case concerns a 30-year-old female with a medical history of depression, who experienced the unexpected events of back pain, headache, nausea and pyrexia on the same day after the second dose of mRNA-1273 (Moderna CoviD-19 Vaccine). The rechallenge was unknown as there''s no information available about the first dose. The benefit-risk relationship of mRNA-1273 (Moderna CoviD-19 Vaccine) is not affected by this report.


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