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

This is VAERS ID 919721



Case Details

VAERS ID: 919721 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Iowa  
Vaccinated:2020-12-30
Onset:2020-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Facial paralysis, Hypoaesthesia, Paraesthesia oral
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Chocolate, INH
Diagnostic Lab Data: 12/31/20: Follow up with PCP who sent me to Medical Center for possible stroke.
CDC Split Type:

Write-up: Tingling in lips 10 minutes after shot administered. Progressive numbness and mild drooping to right side of face (cheek, jaw, chin, neck, tongue, throat). Numbness in right arm down to 3rd, 4th and 5th fingers. Full function was still intact.


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