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From the 11/26/2021 release of VAERS data:

This is VAERS ID 908629

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Case Details

VAERS ID: 908629 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Nebraska  
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 025I20-2A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypersensitivity, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D3, Reglan, Nortriptyline, Topamax, Potassium Chloride, Topomax, Crestor, Aimovig autominjector, Ubrelvy, Verapamil, Valacyclovir, Cardizem
Current Illness:
Preexisting Conditions: Migraine disorder, sinus tachycardia, familial combined hyperlipidemia
Allergies: Latex allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Urticaria, allergic reaction to COVID-19 vaccine, treatment with famotidine and benadryl, along with prednisone for 5 days.


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