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

This is VAERS ID 930518

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Case Details

VAERS ID: 930518 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-01-05
Onset:2021-01-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood potassium decreased, Blood pressure abnormal, Dehydration, Echocardiogram normal, Electrocardiogram normal, Fatigue, Feeling abnormal, Flushing, Headache, Heart rate increased, Peripheral swelling, Pulse abnormal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (broad), Hypersensitivity (broad), Dehydration (narrow), Hypokalaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Dupuytrens, plantar fibromatosis, peyronies
Allergies: None
Diagnostic Lab Data: Low potassium, cardio gram was normal, ekg was normal just very rapid beat, I was told most of my lands were great, had signs of mild dehydration.
CDC Split Type:

Write-up: After about 15 min: hr went to over 170bpm , flushed sensation, brain fog, was driving at the time and my brain wouldn?t figure out how to call 911 , eventually I figured it out but it took extreme mental effort. Paramedics came and my pulse was From 100 - 170 changing rapidly, bp 150-175/x changing rapidly, symptoms would come and go about 8 times on way to hospital. In ER same thing then about 2 hrs go by and then all started again. Pulse remained at 90- 100bpm at least until 2am. (My resting hr is between 40 and 50, my normal bp is usually sub 120/80) I later realized my hands were swollen, mostly on my left side. Lingering symptoms include brain fog, tiredness, and headache. Maybe an exasperating issue was I had low potassium levels likely making symptoms worse - I worked out heavily early in the morning, probably had low intake of potassium that day and day before, and maybe slightly dehydrated from my workout - I do Functional lifting, run, and other types of exercise regularly.


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