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

This is VAERS ID 927069

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Case Details

VAERS ID: 927069 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-01-07
Onset:2021-01-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Nausea, Pain in extremity, Pharyngeal hypoaesthesia
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Clammy, dizzy, nauseas, left arm pain and numb throat. She was monitored on exam table and she rested and was given Benadryl and Claritin and started to feel better by 45-60 minutes. By 2 hours she was completely normal and cleared to leave.


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