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From the 11/12/2021 release of VAERS data:

This is VAERS ID 907058

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Case Details

VAERS ID: 907058 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Alaska  
Vaccinated:2020-12-21
Onset:2020-12-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Swollen tongue, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: cold x3weeks ago. negative for covid.
Preexisting Conditions: Fibromyalgia benign hypermobility syndrome
Allergies: opioids- nausea/vomiting Phenergan - skin/ itchiness
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: itchiness in throat, mild tongue swelling. Administered Benadryl 50 mg. sx resolved 5-6 minutes after medication administered


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