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

This is VAERS ID 907250

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Case Details

VAERS ID: 907250 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2020-12-23
Onset:2020-12-23
   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 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Dysphagia, Nausea, Paraesthesia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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: Buspar, Ventolin, Nuvaring, Phenergan
Current Illness: n/a
Preexisting Conditions: Asthma
Allergies: Sulfa Medications
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Vomiting, Cheeks feel tingling, Slight difficulty swallowing. Rest and will take oral Benadryl when gets home. Will take Phenergan for nausea when gets home as well. Starting to feel better after 2 hours.


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