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

This is VAERS ID 908537



Case Details

VAERS ID: 908537 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Washington  
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 037K20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Flushing, Hypersensitivity, Lacrimation increased, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Angioedema (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Hypersensitivity reaction. Redness, flushing, runny nose, watery eyes. Gave Diphenhydramine 25mg PO. Symptoms subsided after about 20 minutes. Patient stayed in the clinic for observation for approximately 1 hour. Advised to call 911 and seek emergency medical care if any symptoms started again after leaving the clinic. Patient expressed understanding.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=908537

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