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

This is VAERS ID 1763105

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Case Details

VAERS ID: 1763105 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Washington  
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 019F21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Cold sweat, Headache, Hyperhidrosis, Inappropriate schedule of product administration, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Vomiting, nausea, migraine, body aches. 28 years old, 09/03/2021, injection, Moderna first vaccine
Other Medications: Acyclovir, Bupropion, Omeprazole, Norgestimate, vitamin c, vitamin d, cranberry vitamin, calcium, vitamin D3, B-12, Biotin, Multi Vitamin
Current Illness: I had the flu the previous week before getting the vaccine
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nauseous, vomiting, body aches, cold and hot sweats, fever, headache, weakness, abdominal pain, can?t keep any food down, just keep vomiting.


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