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

This is VAERS ID 906931



Case Details

VAERS ID: 906931 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Colorado  
Vaccinated:2020-12-22
Onset:2020-12-22
   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: Military       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Headache
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Epidural steroid injection approximately 10 days prior
Current Illness:
Preexisting Conditions:
Allergies: Shellfish, Iodine, Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt experienced headache and dizziness immediately after injection. Approximately 30 mins later the patient began experiencing chest tightness. The patient received 50mg Benadryl and was transferred to the emergency department within about 20 mins.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=906931

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