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

This is VAERS ID 917865

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Case Details

VAERS ID: 917865 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2020-12-29
Onset:2020-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Headache, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: viral cold 3 weeks before (throat pain, chills, fever, fatigue) - NOT COVID (tested negative), or Flu (symptoms only lasted 48 hours and lower fevers)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: intense chills and arm pain starting ~5 hours after shot (child faded within 24 hours) arm soreness lasted ~3 days general intense fatigue and light-headedness/ headache; decreased and went away after 48 hours


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