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

This is VAERS ID 1774964

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Case Details

VAERS ID: 1774964 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-27
Onset:2021-10-04
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Hyposmia, Nasal congestion
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Clonidine; Triamterene-HCTZ
Current Illness: none
Preexisting Conditions: esophageal dysmotility, history of tobacco use, HTNl GERD, gastric ulcer
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: cough on 10/4/21 That lasted a couple of days, and has nearly resolved. She has some nasal congestion and decreased smell as a result of congestion. She was with her brother 10 days ago, and afterward he ended up getting sick and being diagnosed with COVID-19.


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