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From the 11/19/2021 release of VAERS data:

This is VAERS ID 907194

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Case Details

VAERS ID: 907194 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2020-12-22
Onset:2020-12-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, Lopressor, Lisinipril/HCTZ, Rosuvastatin
Current Illness: None
Preexisting Conditions: CAD, HTN
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine- Fever, Chills, Muscle and joint aches, headache, fatigue. Self limiting, went to bed and woke feeling better. Only fatigue now.


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