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From the 10/15/2021 release of VAERS data:

This is VAERS ID 908534



Case Details

VAERS ID: 908534 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Ohio  
Vaccinated:2020-12-23
Onset:2020-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Eye pruritus, Flushing, Lacrimation increased, Ocular hyperaemia, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Glaucoma (broad), Lacrimal disorders (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: mirtazapine 25mg QHS
Current Illness: none
Preexisting Conditions: none
Allergies: Zofran, Bee stings
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient started with watery red eyes and face was flushed. initial vital signs after notice of reaction was Bp 120/88 then noticed mild hives on neck and behind ears. Decided to give patient Benedryl 50 mg IM in Right Deltoid at 1:12pm and retook vitals at 1:20 Bp 118/74 pulse 86 and SAO2 99% on room air. Vitals at 1:36 pm were BP 116/84 pulse 90 and SAO2 97% on room air. Redness and eye watering and itching improved. Spoke with patient again today she says she still has a slight itchiness between fingers and will consult physician prior to second dose.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=908534

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