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

This is VAERS ID 919372



Case Details

VAERS ID: 919372 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2020-12-22
Onset:2020-12-31
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / UNK RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Ear pain, Eating disorder, Eyelid function disorder, Facial paralysis, Headache
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: adderall xr meloxicam baclofen pristiq
Current Illness: n/a
Preexisting Conditions: migraines and asthma
Allergies: shellfish All nuts except almonds sulfa drugs lexapro penicillin amoxicillin
Diagnostic Lab Data: CAT scan and blood work both on 01/02/2021
CDC Split Type:

Write-up: Bell''s Palsy on the right side of my face. ear ache, head ache all on the right side. droopiness of the right eye and right side of lips. inability to fully shut my eye., difficulty eating and drinking. Attempted to go to an urgent care on 1/02/2021, but they sent me to the ER. ER evaluated me and sent me home with antivirals and steroids. I was sent home with Prednisone and Acyclovir


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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=919372


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