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

This is VAERS ID 1775640

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Case Details

VAERS ID: 1775640 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-26
Onset:2021-10-01
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939901 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anosmia, Feeling abnormal, Headache
SMQs:, Taste and smell disorders (narrow), Dementia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth Control
Current Illness: None
Preexisting Conditions: PCOS
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Loss of taste and smell for two weeks, "brain fog", persistent headache


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