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From the 1/7/2021 release of VAERS data (an older release, current is 1/14/2022):

This is VAERS ID 919604

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Case Details

VAERS ID: 919604 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Mississippi  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Anion gap decreased, Aspartate aminotransferase normal, Basophil count normal, Basophil percentage decreased, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium normal, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood magnesium normal, Blood potassium decreased, Blood sodium normal, Blood thyroid stimulating hormone normal, Blood urea nitrogen/creatinine ratio, Blood urea normal, Carbon dioxide decreased, Chest X-ray normal, Chest discomfort, Cough, Dizziness, Eosinophil count decreased, Eosinophil percentage decreased, Glomerular filtration rate, Haematocrit normal, Haemoglobin normal, Hypoaesthesia, Immature granulocyte count increased, Immature granulocyte percentage increased, Injection site hypoaesthesia, Injection site pain, Lymphocyte count decreased, Lymphocyte percentage decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume normal, Monocyte count normal, Monocyte percentage decreased, Nausea, Neutrophil count increased, Neutrophil percentage increased, Pain in extremity, Platelet count normal, Protein total normal, Red blood cell count normal, Red blood cell nucleated morphology, Red cell distribution width increased, Throat tightness, Troponin normal, White blood cell count normal
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Haematopoietic leukopenia (narrow), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Myelodysplastic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amitriptyline 25 mg PO QHS Bupropion XL 150 mg PO Daily Cyanocobalamin 1000 mcg PO once weekly Ferrous sulfate DR 324 mg PO Daily Levothyroxine 100 mcg PO Daily Methocarbamol 500 mg PO TID prn muscle spasms Scopolamine 1.5 mg patch transder
Current Illness:
Preexisting Conditions: Anemia Asthma Depression Hypothyroidism secondary to thyroid cancer s/p thyroidectomy Hypertension Migraines Vertigo
Allergies: No known allergies
Diagnostic Lab Data: Chest X-ray (12/30/20 @ 1737): The cardiac and mediastinal silhouette are unremarkable. The lungs are free of infiltrates and masses. I see no acute chest disease on today''s film. CBC w/diff (12/30/2020 @ 1658) WBC: 9.0 RBC: 4.38 Hemoglobin: 13.3 Hematocrit: 39.8 MCV: 90.9 MCH: 30.4 MCHC: 33.4 RDW SD: 40.4 Platelet: 264 MPV: 9 NRBC Percent: 0.0 NRBC Absolute: 0.000 Absolute Neutrophil: 8.4 (H) Lymphocyte Absolute: 0.4 (L) Monocytes Absolute, Automated: 0.11 Absolute Eosinophil: 0.00 (L) Basophil Absolute: 0.03 Absolute Immature Granulocytes: 0.03 (H) Neutrophil percent: 93.6 (H) Lymphocyte percent: 4.6 (L) Monocyte percent: 1.2 Eosinophil percent: 0.0 Basophil percent: 0.3 Immature Granulocytes percent: 0.30 (H) CMP (12/30/2020 @ 1658) Sodium: 136 Potassium: 3.3 (L) Chloride: 106 CO2: 21 Anion gap: 9 Glucose: 137 (H) BUN: 15 Creatinine: 1.01 BUN/Creatinine Ratio: 14.9 Calcium: 9.2 Protein total: 7.9 Albumin: 4.6 AST: 12 ALT: 17 ALP: 50 eGFR non-African American: $g60.0 eGFR African American: $g60.0 Bilirubin total: 0.4 Magnesium: 2.0 TSH: 2.52 Cardiovascular (12/30/2020 @ 1658) Troponin: <0.015
CDC Split Type:

Write-up: Presented to the ED after developing chest tightness, cough, lightheadedness, and throat closing sensation. She received the Moderna COVID-19 vaccine on the morning of presentation. Within 15 minutes of receiving the vaccine she developed pain and numbness, starting at the injection site traveling down the ulnar aspect of her arm, and nausea. Over the next several hours she continued to develop worsening nausea, chest tightness, cough, lightheadedness, and the sensation that her throat closing. She took PO Benadryl 25mg; however, her symptoms were not alleviated. She was subsequently evaluated in the ED. ? Received PO Benadryl 25mg, IV Benadryl 25mg, Epinephrine 0.3mg x 2, IV Famotidine 20mg, IV Solumedrol 125mg & 60mg, DuoNebs x 3, Racepinephrine x 1.

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