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

This is VAERS ID 907331

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Case Details

VAERS ID: 907331 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Arizona  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Asthenia, Chest discomfort, Dizziness, Hypoaesthesia, Immediate post-injection reaction, Nausea, Palpitations, Rash macular
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (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: Cetirizine, Advil,
Current Illness: No
Preexisting Conditions: ASTHMA
Allergies: NDKA
Diagnostic Lab Data: ED administrated methylprednisolone sodium succinate 125mg, Benadryl 50 mg, and Ativan 1mg IV.
CDC Split Type:

Write-up: Employee presented for COVID 19 vaccination: Survey reviewed, no history of Anaphylaxis reaction Moderna 1st dose given today to Left arm. She immediately developed Numbness to her body, chest tightness, and abdominal discomfort. Remained Alert and oriented, voiced concerned she felt like she was going to pass out. She developed blotchy skin to chest and neck area within minutes of injection. Patient sat in a wheelchair. Vital taken: BP 140/98 Pulse 123, given water to drink, tolerated well. She quickly reported she continued with above stated ymptoms, and continued with nausea, blotchy skin, heart racing and weakness. She was given 0.3mg of Epinephrine IM to right arm and taken to the ED

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