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From the 6/11/2021 release of VAERS data:

This is VAERS ID 1042915



Case Details

VAERS ID: 1042915 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-25
Onset:2021-02-10
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L26A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Autoimmune hepatitis, Blood test, Guillain-Barre syndrome, Immunoglobulin therapy, Magnetic resonance imaging
SMQs:, Hepatitis, non-infectious (narrow), Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Valtrex 500 BID, Benicar 40 QD, 81 ASAS QD, Vitamin Ds 15000U daily
Current Illness: None
Preexisting Conditions: HTN, alpha one antitrypsin carrier (MS phenotype)
Allergies: PCN
Diagnostic Lab Data: LP X 2, Contrasted ad un-contrasted MRI holo spine X 2, multiple blood tests
CDC Split Type:

Write-up: Guillain-Barr? syndrome. So far hospitalized =X 7 days, on day 3 of IV IG with ICC line, then planned 3 days of high dose soleumedrol, then plasmapheresis Auto-immune hepatitis


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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=1042915


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