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

This is VAERS ID 1454758



Case Details

VAERS ID: 1454758 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pharyngeal hypoaesthesia, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient called an hour after receiving the shot stating she could feel her throat swelling slightly and having a feeling of numbness throughout her throat and tongue. She said she had no trouble breathing, swallowing fluids or any chest pain. It was recommended to take 2 benadryl tablets now (4:45pm) and 2 tablets before she goes to bed. I had the father get on the phone as well, tell educate him on monitoring her breathing. She was urged to see a doctor or call 911 if breathing issues start or swelling gets worse. I asked her to call the store first thing tomorrow morning when we open to see if there was any relief from the benadryl or if symptoms got worse.


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