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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1761265

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Case Details

VAERS ID: 1761265 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0918214 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chills, Cough, Headache, Myalgia, Nausea, Pain, Pain of skin, Pyrexia, Renal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (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:
Other Medications: Metoprolol. Thyntroid. vitamin b,
Current Illness: none
Preexisting Conditions: A-fib Thyroid removal fast heart rate
Allergies: Latex, Benadryl, ASA, Lidocaine,Nuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea , Headache, Chills, Body aches, skin pain, kidney pain, back pain, coughing, fever, joint and muscle pain,


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