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

This is VAERS ID 1777321

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Case Details

VAERS ID: 1777321 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939901 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pain, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (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: Multivitamin, calcium, bilberry, dandelion, vitamin B, D & E, lutein.
Current Illness: None.
Preexisting Conditions: None.
Allergies: Minor allergy to pork.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Minor: in the hours following the injection, I experienced headache, slight fever (+1 degree), slightly sore throat. All resolved that day. Moderate: the next day, I experienced high levels of arm pain around the injection site. Pain was concentrated in the muscle and was painful when moving the arm or applying pressure to the affected area. I had full range of motion in the arm. The second day after injection, arm pain was slightly reduced and seems to be gradually improving. I also began to experience extreme tiredness and fatigue. Current events are ongoing.


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