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

This is VAERS ID 907738

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Case Details

VAERS ID: 907738 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2020-12-22
Onset:2020-12-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ear swelling, Erythema, Lip swelling, Pharyngeal erythema
SMQs:, Anaphylactic reaction (broad), Angioedema (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: protonix, rosuvastatin
Current Illness:
Preexisting Conditions:
Allergies: Fiorinal - shortness of breath iodinated diagnostic agents - anaphylaxis Meperidine - shortness of breath latex - rash penicillins - rash tetracycline - rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 35 minutes after patient received the vaccine, she noted redness around her chest and neck, goin up to her face and both ears. Ears were swollen. She was transferred to the ED for evaluation, where it was noted that she had redness of her throat and chest with slight swelling of her lips. In the ED, she was given prednisone 40mg PO and famotidine 40mg PO. She was observed and discharged after ~90 minutes.


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