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

This is VAERS ID 1775757

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Case Details

VAERS ID: 1775757 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FR3592 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: FOOD, PENICILLIN
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: PATIENT EXPERIENCED DIFFICULTY BREATHING/THROAT CLOSING UP ABOUT 5 MINUTES AFTER THE VACCINE. GAVE PATIENT ONE DOSE OF 0.3MG EPINEPHRINE AND CALLED EMERGENCY


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