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

This is VAERS ID 933997



Case Details

VAERS ID: 933997 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Illinois  
Vaccinated:2020-12-30
Onset:2021-01-05
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site pruritus, Injection site swelling, Petechiae
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies: Cardizem
Diagnostic Lab Data: CBC - normal
CDC Split Type:

Write-up: On 1/4 developed dime sized redness over vaccine site which on 1/5 enlarged with firmness, erythema and puritus. On 1/6 developed swelling to antecubital area which was gone by 1/7. On 1/7 developed erythema and petechiae to both upper arms.


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