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

This is VAERS ID 910059

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Case Details

VAERS ID: 910059 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2020-12-23
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2020-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute kidney injury, Endotracheal intubation, Gait inability, Hypoaesthesia, Pyrexia, Respiratory failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dystonia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad), Sexual dysfunction (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? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cetirezen 10 mg Daily, Lasix 20 Mg daily, Gabapentin 400 bid, Glipizide 5 mg daily, lisnopril 5 mg daily, Levothyroxine25mcg daily, Metoxican 7.5 daily, Sertraline 50 daily
Current Illness: none
Preexisting Conditions: Depression, Diabetes ,Hypertension, Hypothyroidism, Obesity
Allergies: Pencillian
Diagnostic Lab Data:
CDC Split Type:

Write-up: Numbness in sole of feet. Unable to walk, develop high fever, resp failure resulting in intubation, acute kidney injury


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