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

This is VAERS ID 1758938

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Case Details

VAERS ID: 1758938 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Diarrhoea, Fatigue, Headache, Injection site pain, Injection site swelling, Nausea, Pain, Pain in extremity, Peripheral swelling, Presyncope, Vaccination site mass
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (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: No
Current Illness: I got sick on 8/30/21. Felt like the flu and pneumonia at the same time. Lasted til 9/13/21
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: I have none. I bought some ibuprofen and slept
CDC Split Type:

Write-up: Injection site pain-still sore Tiredness Whole body was in pain Injection site swelling Nausea Decreased appetite Headache Diarrhea Arm pain Almost fainted when I got injected My hand got swollen I?m still dealing with headaches arm pain site pain. I have a lump where I got vaccine


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