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From the 10/15/2021 release of VAERS data:

This is VAERS ID 906416



Case Details

VAERS ID: 906416 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Texas  
Vaccinated:2020-12-21
Onset:2020-12-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Body temperature increased, Fatigue, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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: synthroid 100 mcg tamsulosin 0.4 mg esomeprozole 40 mg duloxetine 60 mg
Current Illness: none
Preexisting Conditions: none
Allergies: nkda
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: PT states he began feeling tired the afternoon of the vaccination, approx 1500. He rested and woke during the night at 2am with temp of 103.0 and headache, muscle aches. Temp at 3 am was 100.7 and headache/muscle aches. Temp 0900 was 100.0 with headache/muscle aches. Pt denies nausea, vomiting, sore throat. will continue to monitor


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=906416

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