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

This is VAERS ID 1376021



Case Details

VAERS ID: 1376021 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (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? No
Previous Vaccinations:
Other Medications: No additional medication taken
Current Illness: No illness
Preexisting Conditions: No chronic or long-standing conditions
Allergies: Peanuts
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fifteen minutes after injection of Moderna COVID vaccine, patient came back to pharmacy. She was complaining of severe itching and some throat tightness. Patient was given diphenhydramine 50 mg as one time dose. Patient BP was monitored, and monitored signs for breathing problems. Patient stated "felt better" after 30 minutes of receiving diphenhydramine. Blood pressure returned to normal (130/85 mm/hg). Patient has family member pick her up and went home.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1376021


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