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From the 10/15/2021 release of VAERS data:

This is VAERS ID 927096



Case Details

VAERS ID: 927096 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2020-12-28
Onset:2020-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chills, Computerised tomogram abdomen, Computerised tomogram head, Computerised tomogram thorax abnormal, Echocardiogram, Fatigue, Flushing, Generalised tonic-clonic seizure, Hyperhidrosis, Legionella test, Magnetic resonance imaging brain, Myalgia, Pulmonary embolism, Pyrexia, SARS-CoV-2 test, Scan with contrast, Streptococcus test, Ultrasound abdomen
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Embolic and thrombotic events, venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (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? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Venlafaxine 150mg daily Ibuprofen 600mg 2x/week
Current Illness: None
Preexisting Conditions: Mild osteoarthritis
Allergies: N/A
Diagnostic Lab Data: CT head without contrast Blood work CT abdomen/pelvis with contrast Xray chest Covid-19 RT-PCR Legionella and Strep Urine Echo TTE MRI brain with and without contrast MRA head without contrast US abdomen CT chest Pulmonary embolism with contrast
CDC Split Type:

Write-up: Day 2 (12/29/20): Fever (<100 degrees), Mild muscle aches, Fatigue Day 3 (12/30/20): Fatigue, Muscle aches Day 4 (12/31/20): Alternating chills and profuse sweating starting at 8am, Full body flushing, Grand Mal Seizure at 4:30pm


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