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

This is VAERS ID 930455



Case Details

VAERS ID: 930455 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2020-12-29
Onset:2021-01-07
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Diarrhoea, Nausea, Pain, Petechiae, Tenderness
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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: Neurontin, Trazadone, Effexor XR, Premarin, Calcium
Current Illness: None
Preexisting Conditions: no
Allergies: Bactrim-Gi upset EES-Gi upset Lexapro-muscle aches
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Onset January 7.,2021 of nausea, diarrhea, chills and body aches that lasted about 18 hours. Noticed on vaccination arm an area of about 2x2 inches that looked like red petechial hemorrhage that is sore to palpation.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=930455

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