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

This is VAERS ID 907131

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Case Details

VAERS ID: 907131 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Iowa  
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 025J20-2A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Palpitations, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Cardiomyopathy (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin, Alprazolam (as needed), Loratadine, Omeprazole, Vitamin D, Calcium, Multivitamin
Current Illness: None known
Preexisting Conditions:
Allergies: Morphine, Strawberries, Prochlorperazine, Septra, Penicllin, Levaquin, Ciprofloxacin, Cephalexin, Ceftriaxone
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 10-15 minutes after receiving vaccine patient reported that her heart began to race and throat began to swell.


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