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

This is VAERS ID 1715573

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Case Details

VAERS ID: 1715573 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Arizona  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oral mucosal blistering, Oral pain, Oropharyngeal blistering, Oropharyngeal pain, SARS-CoV-2 test negative, Stomatitis, Throat irritation
SMQs:, Severe cutaneous adverse reactions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 40 mg Multi Vitamin Vitamin D Baby aspirin
Current Illness: None
Preexisting Conditions: Kidney Disease Stage 3 High BP
Allergies: Erythromycin - upset stomach
Diagnostic Lab Data: COVID 19 Test - Negative result on 9/15/21
CDC Split Type:

Write-up: Approximately 1.5 hours after receiving shot I felt a sore throat coming on. It continued to feel that way for the next few days. Then on the afternoon of 9/14/21 my mouth and throat started to blister and became very painful. I immediately started to drink ice water to help with the pain. The pain persisted for hours until I fell asleep. I woke up the next morning and the sores seemed to have resolved for the most part, but was unsure of whether or not to receive a second dose. I made an appointment with a doctor to look at and she stated most of it had resolved but noticed some irritation.

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