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

This is VAERS ID 917718

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Case Details

VAERS ID: 917718 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-01-02
Onset:2021-01-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Dizziness postural, Headache, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Tendinopathies and ligament disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced a headache, arm pain (not at site), dizziness when standing. Patient was offered water and snacks. Sat in observation area for 30 minutes. Headache and dizziness with standing continued, after 30 minutes patient reported chest tightness. Caregiver was immediately taken to the Emergency Room for assessment.


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