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From the 9/3/2021 release of VAERS data:

This is VAERS ID 1430389



Case Details

VAERS ID: 1430389 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Smoker, Heart Disease
Preexisting Conditions: Heart Disease
Allergies: NKDA
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Wife called to report that patient developed a generalized rash throughout the body the night after receiving Moderna Covid shot. She provided him with Benadryl. Next morning his face was swollen and she decided to call the pharmacy. I advised her to provided Benadryl again and to take him to emergency room. Difficult breathing was not reported.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1430389


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