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

This is VAERS ID 924539

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Case Details

VAERS ID: 924539 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-06
Onset:2021-01-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Dizziness, Flushing, Nausea, Oropharyngeal pain, Retching, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol Inhaler, Nortriptyline, baclofen
Current Illness: none
Preexisting Conditions: osteio arthritis, joint hyper mobility, chronic migrans, fibromyalgia, IBS,
Allergies: Penicillin and mushrooms, and nsaid.
Diagnostic Lab Data: 01/06/21-Blood panels and vital signs.
CDC Split Type:

Write-up: At 10:12 am, Client c/o of sore throat, tightness in throat that relieve quickly, nausea, dry heaves, flushed, light headed and dizziness. Called for EMT. They arrive at 10:25 am and transported her to the local hospital for observation. 01/06/21-Treatment in hospital blood draw, medications given Zofran, Decadron, Benadryl, and Pepcid, and IV fluids. Discharged home at 1244.


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