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From the 12/30/2020 release of VAERS data (an older release, current is 1/14/2022):

This is VAERS ID 907486

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Case Details

VAERS ID: 907486 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2020-12-22
Onset:2020-12-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Headache, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (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: none
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache, injection site arm pain


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