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

This is VAERS ID 957020

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Case Details

VAERS ID: 957020 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-06
Onset:2021-01-11
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Petechiae, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol; Atorvastatin; Prozac; Glucosamine & chondroitin; Turmeric, Probiotic; Hair, Skin, & nails vitamins
Current Illness: None
Preexisting Conditions: HTN, hyperlipidemia, depression, and anxiety
Allergies: Norvasc, ace inhibitors; codeine
Diagnostic Lab Data: None yet. I need to see my PCP
CDC Split Type:

Write-up: Moderna COVID -19 Vaccine EUA. Rash on arms on & off the past week. Itching from rash. Right upper arm petechia noted today. Will try to get appt 1/20 to see my PCP and get CBC with diff & platelets


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