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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1700484

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Case Details

VAERS ID: 1700484 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphagia, Rash
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pandoprozal
Current Illness:
Preexisting Conditions: Acid Reflux
Allergies: Shrimp
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: I received a rash within 5 minutes of having the vaccine. It started to spread to my back and chest. The pharmacist called the ambulance and gave me Benadryl. I went to the ER, and they kept me for 5 hours. They also gave me IV steroids. My throat also felt a little tough to swallow. I went and saw my doctor and he prescribed steroids for the rash as well.


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