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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1830710

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Case Details

VAERS ID: 1830710 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-04-22
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Fatigue, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Tightness of chest; Wheezing; Fatigue; This spontaneous case was reported by a consumer and describes the occurrence of CHEST DISCOMFORT (Tightness of chest), WHEEZING (Wheezing) and FATIGUE (Fatigue) in a 15-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 009C21A and 022C21A) for COVID-19 vaccination. No Medical History information was reported. On 22-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 20-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient experienced CHEST DISCOMFORT (Tightness of chest), WHEEZING (Wheezing) and FATIGUE (Fatigue). At the time of the report, CHEST DISCOMFORT (Tightness of chest), WHEEZING (Wheezing) and FATIGUE (Fatigue) outcome was unknown. No concomitant medication was mentioned. No treatment medication was mentioned. This case was linked to MOD-2021-359055 (Patient Link).


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