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

This is VAERS ID 911854

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Case Details

VAERS ID: 911854 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2020-12-23
Onset:2020-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2020-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Neck pain, Pain, Pain in extremity
SMQs:, Retroperitoneal fibrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losarten, pravastan, B-12
Current Illness: High blood pressure, cholestrol
Preexisting Conditions: high blood pressure, cholesterol, obesity
Allergies: allergy to pineapple skin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: I received the vaccine shot on 12/23/20 at 3 pm. By 12/24/20, I had pain in my left arm that radiated to my neck and back on the left side. Over the past 4/5 days, I continue to have pain in my left arm, back and neck


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=911854


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