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

This is VAERS ID 908540



Case Details

VAERS ID: 908540 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Maine  
Vaccinated:2020-12-24
Onset:2020-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Lip swelling, Paraesthesia oral, Tachycardia
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: Ocella
Current Illness:
Preexisting Conditions:
Allergies: Amoxicillin (hives)
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 30 minutes after receiving vaccination, patient started to have tingling and mild swelling in her lips as well as tachycardia. Vital signs taken. Heart rate was 102 bpm, respiratory rate 18, blood pressure 144/80, O2 Sat 98%. Received cetirizine 10 mg PO. Symptoms resolved within one hour of receiving cetirizine.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=908540

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