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

This is VAERS ID 1757315

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Case Details

VAERS ID: 1757315 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Decreased appetite, Erythema, Fatigue, Feeling hot, Headache, Myalgia, Pruritus, Pyrexia, Swelling, Vaccine positive rechallenge
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), 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 side effects on dose 2 of Moderna Covid vaccine
Other Medications: Levoxyl, collagen, vit D
Current Illness:
Preexisting Conditions: Autoimmune disorder, prediabetic, hypothyroidism
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Severe Chills onset 11pm on 9/30/21, muscle/joint pain/fever/loss of appetite/fatigue onset 10/01/21 AM and lasting through 10/02/21 11pm, headache onset 10/02/21 and lasting 12 hours, covid arm onset 10/03/21 itching, swelling, redness, and warm to the touch.


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