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

This is VAERS ID 1776415

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Case Details

VAERS ID: 1776415 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-01
Onset:2021-10-10
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dizziness, Headache, Nausea, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), 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: Cymbalta
Current Illness:
Preexisting Conditions: Hashimoto''s thyroiditis
Allergies: Peanut, chocolate
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe headache, nausea, dizziness and chills. Rash on chest and neck.


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