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

This is VAERS ID 913568

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Case Details

VAERS ID: 913568 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2020-12-29
Onset:2020-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Heart rate increased, Hot flush, Injection site pain, Injection site rash, Nausea, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Dehydration (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: Protonix
Current Illness: Shortness of breath in the last month
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Nausea, "felt hot", light headed, dizzy, face tingling, elevated heart rate, rash to arm of injection site, soreness to injection site. Stayed for observation. Currently having on and off "hot flashes", and slightly light headed. Other symptoms have resolved.


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