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

This is VAERS ID 932915



Case Details

VAERS ID: 932915 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Washington  
Vaccinated:2020-12-29
Onset:2021-01-08
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Contusion, Haematocrit normal, Haemoglobin normal, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mouth haemorrhage, Platelet count decreased, Red blood cell count normal, Red cell distribution width normal, Thrombocytopenia, White blood cell count normal
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Accidents and injuries (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zoloft (sertraline), vitamin D, cetirizine (zyrtec)
Current Illness: None
Preexisting Conditions: Anxiety, history of anti-thyroglobulin antibodies
Allergies: None
Diagnostic Lab Data: CBC 1/8/21 - WBCs 8.65, RBCs 4.47, Hg 13.7, Hct 40, MCV 89, MCH 30.6, MCHC 34.3, Plts 1** (d) C, RDW 11.8%.
CDC Split Type:

Write-up: Severe thrombocytopenia (plts 3k/uL), oral mucosal bleeding, bruising


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