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

This is VAERS ID 907098

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Case Details

VAERS ID: 907098 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2020-12-22
Onset:2020-12-22
   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 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Injection site erythema, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received Moderna COVID vaccine at 1926. She completed standard 15 min observation time and was dismissed from clinic. Patient returned to clinic at 2000 with redness at injection site, itching, chills. BP 126/90 and pulse 86, patient able to speak comfortably. Diphenhydramine 25 mg given orally. Patient observed for 36 minutes. All symptoms resolved and observed redness to left deltoid completeely resolved. No complaints of shortness of breath or difficulty breathing. Patient discharged from clinic to another facility with appropriate follow up instructions. Patient texted ahead to her preceptor that she is en route.


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