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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 919665

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Case Details

VAERS ID: 919665 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2020-12-29
Onset:2020-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Blood test, Chest X-ray, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synthroid Claritin Dexilent Terbinafine Vitamin D & B12
Current Illness:
Preexisting Conditions: Hypothyroid GERD
Allergies: Bactrim
Diagnostic Lab Data: Blood work 12/30/20 Chest X-ray 12/30/20
CDC Split Type:

Write-up: Severe joint aches, fever-type symptoms, nausea


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210107&IDNUMBER=919665


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