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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1371057



Case Details

VAERS ID: 1371057 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-22
Onset:2021-06-01
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash, Injection site swelling, Rash erythematous, Rash pruritic, Swelling of eyelid
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Periorbital and eyelid disorders (narrow), 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: none but multivitamin
Current Illness: none
Preexisting Conditions: none
Allergies: sulfa and nickel
Diagnostic Lab Data: none
CDC Split Type:

Write-up: I first got a swollen arm at site, and a slight rash, which went away then came back a week later slightly. then I developed what I thought were bug bites on my eyelids, itchy and red bumps. The next day I had a few more. The third day I woke with my eyes almost swollen shut and more itchy red bumps on my face, spread to my neck, now my chest and back. a few at a time


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