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

This is VAERS ID 931507

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Case Details

VAERS ID: 931507 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-07
Onset:2021-01-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L 20A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Cardiac stress test, Cardiovascular evaluation, Chest X-ray, Chest discomfort, Dizziness, Electrocardiogram ST segment elevation, Gait inability, Malaise, Myocardial necrosis marker, Nausea, Scan myocardial perfusion, Speech disorder
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lord attain Trazadone
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: EKG, chest X-ray, cardiac markers , stress test, nuclear stress scan.
CDC Split Type:

Write-up: 8 hours after vaccine I experienced stomach pain and nausea. I then became very ill and extremely weak. I was laying on floor. Very difficult to talk and very dizzy. Unable to walk. Called 911 and went to ER. Had chest pressure and cardia work up was done. Dx wi ST elevation.


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