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

This is VAERS ID 907909

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Case Details

VAERS ID: 907909 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Missouri  
Vaccinated:2020-12-23
Onset:2020-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Dry mouth
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Dehydration (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: mucolytic
Current Illness: recent history of Clinically diagnosed bronchitis and treated with OTC medication (mucolytic) by pcp
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: Initial VS: BP: 142/84, HR: 111, RR: 24 Spo2% 99/RA, . End VS: BP: 118/94, HR: 82, RR: 16,, SpO2: 100%/RA. Patient denies shortness of breath or difficulty breathing, Lung sounds are clear. Patient states she feel better and is conscious alert and oriented X4. She was placed in he monitoring room within the vaccination clinic for intermittent monitoring of VS and reaction response at 1317.
CDC Split Type:

Write-up: Patient given covid-19 vaccine at 1218, Symptoms started at 12:25 (dry cough, dry mouth). Benadryl 25mg by mouth given at 1238. No previous history of vaccination reaction. Of note: recent history of Clinically diagnosed bronchitis and treated with OTC medication (mucolytic) by pcp, no ATB given. No NKDA, no recent fever or illness in 24hours. Initial VS: BP: 142/84, HR: 111, RR: 24 Spo2% 99/RA, . End VS: BP: 118/94, HR: 82, RR: 16,, SpO2: 100%/RA. Patient denies shortness of breath or difficulty breathing, Lung sounds are clear. Patient states she feel better and is conscious alert and oriented X4. She was placed in he monitoring room within the vaccination clinic for intermittent monitoring of VS and reaction response at 1317.


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