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From the 9/17/2021 release of VAERS data:

This is VAERS ID 919325



Case Details

VAERS ID: 919325 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2020-12-30
Onset:2020-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Dyspnoea, Headache, Rhinorrhoea, Vasculitis
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vasculitis (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi-Vitamin, Hair, Skin & Nail vitamin, Vitamin Zinc, Vitamin B complex, Nasal Spray Flonase
Current Illness: Sinus headache
Preexisting Conditions: Vasculitis
Allergies: Ibuprofen, Cipro, bananas
Diagnostic Lab Data: none
CDC Split Type:

Write-up: I received my shot at appx 1300 hours. By 1700 hours I had a flare up of Vasculitis symptoms. I began to get little red dots on both of my lower legs a total of about 10. They began really light and over the night got brighter and bigger. I went to the doctor the next morning and was given a prescription for a steroid and antibiotic which I first took at 2000 hours on 12/31/2020. By the next evening my dots began to get lighter. As of today all but one have faded away. The one I have is really light. I did have some of the usually listed symptoms, slight headache, runny nose, hard to breathe.


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