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From the 5/7/2021 release of VAERS data (an older release, current is 11/12/2021):

This is VAERS ID 906394

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Case Details

VAERS ID: 906394 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2020-12-21
Onset:2020-12-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site pain, Vertigo
SMQs:, Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Glipizide, Losartan, Simvastatin, Vit D, Flomax
Current Illness:
Preexisting Conditions: Stable T2DM, Stable HTN, BPH, OA
Allergies: Penicillin, Tincture of Benzoin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Left UE injection site soreness 4 hours post. Severe vertigo approximately 10 hours after, lasting about 4 hours.


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