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

This is VAERS ID 907302

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Case Details

VAERS ID: 907302 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: New York  
Vaccinated:2020-12-21
Onset:2020-12-22
   Days after vaccination:1
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: Chills, Chromaturia, Eye swelling, Fatigue, Headache, Myalgia, Nausea, Pain, Pyrexia, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vit B,b12, finasteride, vascepa, Pepcid, Tylenol, naproxen, Benadryl, and androgel, MGUS ( autoimmune disorder)
Current Illness: none
Preexisting Conditions: low testosterone, high triglucerides
Allergies: none
Diagnostic Lab Data: none
CDC Split Type: vsafe

Write-up: 12/23@9:35am EST- Caller stated on12/22/20 at midnight he felt fever 103.0, chills, muscle soreness and aching, nausea and extreme fatigue. Caller called Primary and was told to take Tylenol 1gr. Benadryl and naproxen for headache and body aches. Rash covered arms , neck and thighs and patika on elbow and armpit. This morning rash is still prominent, eyes are swollen and urine is bright red. Caller is awaiting primary to call back.


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