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From the 9/17/2021 release of VAERS data:

This is VAERS ID 906800



Case Details

VAERS ID: 906800 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Unknown  
Vaccinated:2020-12-21
Onset:2020-12-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J2OA / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Cough, Headache, Pain
SMQs:, Anaphylactic reaction (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, body aches, mild cough, headache


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