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

This is VAERS ID 914082

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Case Details

VAERS ID: 914082 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
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 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Apnoea, Chest X-ray, Dizziness, Dyspnoea, Erythema, Headache, Hot flush, Hypoaesthesia, Hypoaesthesia oral, Hypotension, Swelling face, Tremor
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Covid-19 on 12/16/2020
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: Chest x-ray
CDC Split Type:

Write-up: Dizzy, light headed, "hot flash", red face, facial swelling, hypotension, apnea, shaking, mouth numbness. EpiPen given and sent to the emergency department at Hospital. Currently have dyspnea, numbness in arms and legs, headache.


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