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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1697164

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Case Details

VAERS ID: 1697164 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Laboratory test, Mononucleosis heterophile test negative, Mouth swelling, Pharyngeal swelling, SARS-CoV-2 test, Streptococcus test negative
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hormone medication
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa iodine shellfish. Percocet Bactrim
Diagnostic Lab Data: Phone appointment on 9-9 with primary care and emergency room on 9-10. Tested for covid. Strep throat and mononucleosis all negative other labs were taken as well.
CDC Split Type:

Write-up: Swelling In mouth and throat

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