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

This is VAERS ID 907468

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Case Details

VAERS ID: 907468 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Kansas  
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 025J20-2A / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Confusional state, Fatigue, Feeling cold
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient felt chilled and very tired. She started falling asleep while sitting upright. She also became acutely confused and could not identify what year it is, what her phone code was, etc. 911 was notified, but pt felt better about an hour later and did not go to the emergency department for evaluation.


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