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

This is VAERS ID 907459

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Case Details

VAERS ID: 907459 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Colorado  
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: Military       Purchased by: ?
Symptoms: Condition aggravated, Fatigue, Nausea, Pain in extremity, Sleep disorder, Tinnitus
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Tendinopathies and ligament 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: generic zyrtec
Current Illness: none
Preexisting Conditions: tinnitus
Allergies: lactose intolerant
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA Left arm pain started 15 min post vaccination and has not subsided. General fatigue started 2 hours post vaccination and has not subsided. Nausea started 5 hours post vaccination and subsided by 4:45AM the following day. Tinnitus usually sits at 2 on a scale of 1 to 10 with 10 being obnoxiously loud and distracting causing lack of concentration. Tinnitus started to increase 2 hours post vaccination and topped out at about 8 at around 6 hours post vaccination. Could not sleep well and maybe got 2 hours of sleep due to tinnitus and increasing left arm pain.


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