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

This is VAERS ID 1779068

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Case Details

VAERS ID: 1779068 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Morphine sulfate ER,Famotidine, Verapamil ER, Lamictal XR, Trokendi XR, Levetiracetam ER, Vitamin D, Calcium/vitamin D
Current Illness: None
Preexisting Conditions: Ehlers-danlos syndrome, Sjogren''s syndrome, Hashimoto''s, Chronic pain
Allergies: Keflax, tofranil
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Slight swelling, deep down itching at injection site. Still there on Oct 11


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