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From the 1/14/2022 release of VAERS data:

This is VAERS ID 909432

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Case Details

VAERS ID: 909432 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New York  
Vaccinated:2020-12-26
Onset:2020-12-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20-2A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dyspnoea, Malaise
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: None known
Current Illness: None noted
Preexisting Conditions: None noted
Allergies: NKDA
Diagnostic Lab Data: Transported to Emergency room.
CDC Split Type:

Write-up: Employee was waiting to be observed for the required 15 minutes post vaccination. She started to complain of not feeling well and feeling short of breath. She was immediately assessed by staff and transported to Emergency Department for further evaluation.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=909432


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