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

This is VAERS ID 1785933

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Case Details

VAERS ID: 1785933 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-10-05
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Rash, Rash maculo-papular, Rash pruritic
SMQs:, Anaphylactic reaction (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Parkinson''s disease Multinodal goiter HTN RLS
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: developed macular papular rash over his left leg that is non-blanching extensive, mildly itchy


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