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

This is VAERS ID 1454781



Case Details

VAERS ID: 1454781 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: North Carolina  
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 041C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Pharyngeal swelling, Pruritus, Stridor
SMQs:, Anaphylactic reaction (narrow), Angioedema (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: albuterol, flexeril, Voltaren doxycycline, Lasix, neurotin, atarax, plaquenil, Flonase, allergra, epi pen, Lidocain, Mag oxide, ativerrt, singulair, Minipress, pyridium Phenergan, Zoloft, Verapamil
Current Illness: Obesity, pelvic pain, Gerd, Biliary colic, chronic pain, Rash, anxiety, Chronic diarrhea, vertigo, asthma, Migraines, PTSd,, Depression, IBS, Endometrosis
Preexisting Conditions: same
Allergies: Aspirin, Beef, Motrin, Nsaids, PCN, soy, sulfa, Trazadone, Wheat, Egg Ahesive, Gluten, Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: throat swelling, stridor, redness, itching,


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