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

This is VAERS ID 1758124

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Case Details

VAERS ID: 1758124 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-01
Onset:2021-09-07
   Days after vaccination:98
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Eye pain, Fatigue, Headache, Influenza like illness, Malaise, Myalgia, Pain in extremity, Photophobia, SARS-CoV-2 test, Thirst, Tinnitus
SMQs:, Rhabdomyolysis/myopathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Test Name: COVID-19 virus test; Test Result: Negative ; Result Unstructured Data: Negative COVID-19 test
CDC Split Type: GBMODERNATX, INC.MOD20213

Write-up: Moderately ill; Eyes sensitive to sunlight; Ringing in ears; Excessive thirst; Light headedness; Flu-like aching; Pain behind eyes; Pain in arm; Fatigue; Muscle ache; Headache; This case was received via regulatory agency (Reference number: GB-MHRA-ADR 25997624) on 26-Sep-2021 and was forwarded to Moderna on 26-Sep-2021. This regulatory authority case was reported by a consumer and describes the occurrence of TINNITUS (Ringing in ears), DIZZINESS (Light headedness), THIRST (Excessive thirst), MALAISE (Moderately ill), INFLUENZA LIKE ILLNESS (Flu-like aching), EYE PAIN (Pain behind eyes), PHOTOPHOBIA (Eyes sensitive to sunlight), PAIN IN EXTREMITY (Pain in arm), FATIGUE (Fatigue), MYALGIA (Muscle ache) and HEADACHE (Headache) in a 32-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 01-Jun-2021, the patient received first dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 06-Sep-2021, received second dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 07-Sep-2021, the patient experienced INFLUENZA LIKE ILLNESS (Flu-like aching) (seriousness criteria disability and medically significant), EYE PAIN (Pain behind eyes) (seriousness criteria disability and medically significant), PAIN IN EXTREMITY (Pain in arm) (seriousness criteria disability and medically significant), FATIGUE (Fatigue) (seriousness criteria disability and medically significant) and HEADACHE (Headache) (seriousness criteria disability and medically significant). 07-Sep-2021, the patient experienced MYALGIA (Muscle ache) (seriousness criteria disability and medically significant). On 09-Sep-2021, the patient experienced DIZZINESS (Light headedness) (seriousness criteria disability and medically significant). On 10-Sep-2021, the patient experienced THIRST (Excessive thirst) (seriousness criteria disability and medically significant). On 22-Sep-2021, the patient experienced TINNITUS (Ringing in ears) (seriousness criteria disability and medically significant). On an unknown date, the patient experienced MALAISE (Moderately ill) (seriousness criteria disability and medically significant) and PHOTOPHOBIA (Eyes sensitive to sunlight) (seriousness criteria disability and medically significant). On 11-Sep-2021, PAIN IN EXTREMITY (Pain in arm) had resolved. At the time of the report, TINNITUS (Ringing in ears), DIZZINESS (Light headedness), THIRST (Excessive thirst), FATIGUE (Fatigue) and MYALGIA (Muscle ache) had not resolved, MALAISE (Moderately ill) outcome was unknown and INFLUENZA LIKE ILLNESS (Flu-like aching), EYE PAIN (Pain behind eyes), PHOTOPHOBIA (Eyes sensitive to sunlight) and HEADACHE (Headache) was resolving. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: negative (Negative) Negative COVID-19 test. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. No relevant concomitant medications were provided. No treatment information was provided. Patient had COVID-19 less than 1 week after 1st vaccine in June 2021 and was moderately ill for 1 month. Patient had three appointments since second vaccine and one full blood count was done which was clear. This case concerns a 32-year-old, female patient with relevant medical history of Covid-19 infection, who experienced the unexpected events of Influenza-like illness, pain in extremity, thirst, dizziness, malaise, eye pain and photophobia approximately 1-4 days after the second dose of Moderna CoviD-19 Vaccine. The unexpected event of Tinnitus occurred 16 days after the second dose of Moderna CoviD-19 Vaccine. The rechallenge was unknown since no information on the events of the first dose was disclosed. The patient''s recent history of Covid-19 infection remains a confounder to the occurrence of events. The benefit-risk relationship of Moderna CoviD-19 Vaccine is not affected by this report. Event seriousness assessed as per Regulatory Authority reporting, citing information from the source document stating that the events resulted in a disabling/ Incapacitating outcome.; Sender''s Comments: This case concerns a 32-year-old, female patient with relevant medical history of Covid-19 infection, who experienced the unexpected events of Influenza-like illness, pain in extremity, thirst, dizziness, malaise, eye pain and photophobia approximately 1-4 days after the second dose of Moderna CoviD-19 Vaccine. The unexpected event of Tinnitus occurred 16 days after the second dose of Moderna CoviD-19 Vaccine. The rechallenge was unknown since no information on the events of the first dose was disclosed. The patient''s recent history of Covid-19 infection remains a confounder to the occurrence of events. The benefit-risk relationship of Moderna CoviD-19 Vaccine is not affected by this report. Event seriousness assessed as per Regulatory Authority reporting, citing information from the source document stating that the events resulted in a disabling/ Incapacitating outcome.


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