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From the 6/4/2021 release of VAERS data:

This is VAERS ID 896636



Case Details

VAERS ID: 896636 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2020-09-28
Onset:2020-10-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2020-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Confusional state, Fatigue, Feeling abnormal, Head discomfort, Memory impairment, Pain in extremity, Peripheral swelling, Physiotherapy, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: 10mg Prozac daily
Current Illness: none
Preexisting Conditions: none
Allergies: tetracycline
Diagnostic Lab Data: OCT 6 RESEARCH CENTER FOR ADVERSE SICK VISTIT/// OCT 8TH MEDICAL CENTER ///OCT 8TH EMERGENCY ROOM/// OCT 13TH PRIMARY CARE///0CT.19TH MED CENTER///OCT.26 PRIMARY CARE ///OCT 30 TH PRIMARY CARE ///NOV 2ND CHIROPRACTIC/// NOV 6TH PHYSICAL THEREAPY/// NOV 9TH CHIROPRACTIC /// NOV 11 NEUROLGY/// NOV 23 DR. ORTHOPEDICS
CDC Split Type:

Write-up: ARM SWELLING WITH PAIN, FEVER, FATIGUE, THEN CONFUSION, FORGETFULNESS, BRAIN FOG, EXTREME HEAD PRESSURE WITH FEVER THAT LASTED 2 WEEKS AFTER VACCINE. ARM AND SHOULDER PAIN CONTINUED TO INCREASE AND STILL PRESENT.


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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=896636


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