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From the 1/15/2021 release of VAERS data:

This is VAERS ID 29516

Case Details

VAERS ID: 29516 (history)  
Form: Version 1.0  
Age: 31.0  
Sex: Female  
Location: Michigan  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1991-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anaphylactoid reaction, Anxiety, Apnoea, Asthma, Dyspnoea, Headache, Paraesthesia, Somnolence, Stupor, Tremor
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Cystospaz, Cytotec, Elavil, Hismanal
Current Illness: Crohn''s disease
Preexisting Conditions: multiple allergies-yellow dye#4,penicillin,iodine,shellfish,erthromycin,motrin,Previous smoker X 1/2 pkg stopped Oct90,ulcerative colitis/w colectomy;colitis stable
Diagnostic Lab Data: Labs drawn 6Mar91;blood gas /w pH of 7.74,"PCo3"(?PCo2)-13,PO2-108, bicarb-18;Hg-13.1.Xray chest-nl;7Mar91 PE-nl
CDC Split Type: EBU910230

Write-up: Rec''d a series of 3 vax according to 0, 1, 6 mo schedule given 7SEP90, 5OCT90, 6MAR91 about 6 1/2 hrs p/3rd dose pt ex. anaphyl rxn (SOB, wheezing); became semi-conscious; admitted to ER - headache;In ER diffuse wheezes, resp rate-28,

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