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

This is VAERS ID 907525

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Case Details

VAERS ID: 907525 (history)  
Form: Version 1.0  
Age: 72.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2020-12-22
Onset:2020-12-23
   Days after vaccination:1
Submitted: 2020-12-23
   Days after onset:0
Entered: 2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 2 LA / -

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Confusional state, Hypertension, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient covid +,on day 13 since identified. received covid 19 vaccine 19 hours prior to fever presentation. patient to receive full medical work up to rule out other medical contributions for fever. Confusion, Fever, HYPERtension & FEVER 101.5 fahrenheit, weakness


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