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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1443162

Case Details

VAERS ID: 1443162 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Senior Living       Purchased by: ?
Symptoms: Anaphylactic reaction, Pharyngeal swelling, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none noted
Preexisting Conditions: none noted
Allergies: Allergic to pork
Diagnostic Lab Data: It is unknown was tests that were performed once patient was transported
CDC Split Type:

Write-up: Approximately 15 minutes post vaccination, patient started to show signs of anaphylactic reaction. Patient stated to the interpreter that her tongue was swelling and her throat was starting to close up. I administered 1 injection of Epi Pen to her left thigh. We summoned the resident RN on site. A pulse oximeter was placed on her left hand. She was administered oxygen via nasal cannula. I called 911 from my cell phone. Paramedics arrived on site in about 5 minutes. The paramedics made the decision to transport her to the local hospital

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