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

This is VAERS ID 909480

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Case Details

VAERS ID: 909480 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2020-12-26
Onset:2020-12-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Electrocardiogram, Heart rate increased, Hypoaesthesia, Palpitations, Paraesthesia, Tachycardia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad), Sexual dysfunction (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: Bactrim
Diagnostic Lab Data: EKG 12/26/20
CDC Split Type:

Write-up: Symptoms started after 2-3 mins of vaccine. Started having numbness, tingling on face, arms, legs, tachycardia up to 144 bpm, dizziness, palpitations, chest tightness. Lasted up to 1 hour. Observed in clinic and went home after 2.5 hrs. At home continued to have on and off palpitations for 2-3 hrs with heart rate increasing to 110 bpm.


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