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

This is VAERS ID 907135

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Case Details

VAERS ID: 907135 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New Jersey  
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 011520A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Injection site erythema, Injection site pain, Injection site rash, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa drugs
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Redness, swelling and tenderness at the injection site Rash appeared at the injection site after 8 hours of administration. Chills and low grade fever


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