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From the 5/7/2021 release of VAERS data (an older release, current is 11/12/2021):

This is VAERS ID 926619

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Case Details

VAERS ID: 926619 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-01-07
Onset:2021-01-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Limb discomfort, Lip pruritus, Petechiae, Pruritus, Rash, Rash erythematous, Sensory disturbance
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Hypersensitivity (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Progesterone
Current Illness: None
Preexisting Conditions: lactose-intolerance, hormone imbalance, vitamin D deficiency
Allergies: cucumber, water melon, bell pepper, strawberries, etc.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Approximately 5 minutes after receiving vaccine, patient experienced itching on upper lip and itching on left upper arm. Appears to have a petechial rash with redness on left upper arm. Itching is stable and not getting worse. Left arm feels a little heavy with some unusual sensation. Initial BP 155/91 HR=80. O2=98%. Repeat BP 137/90 HR=77 O2=97%. Patient declined Benadryl because the symptoms are stable and patient did not want to get sleepy from the Benadryl and patient wanted to return to work. Patient clinically stable. Patient released at 10:15am.


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