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From the 5/7/2021 release of VAERS data (an older release, current is 1/7/2022):

This is VAERS ID 919817

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Case Details

VAERS ID: 919817 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-01-04
Onset:2021-01-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Tylenol and Motrin; Singulair, Nexplanon implant
Current Illness: None
Preexisting Conditions: Asthma, seasonal allergies
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Fever, nausea, body aches


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210507&IDNUMBER=919817


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