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

This is VAERS ID 908656

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Case Details

VAERS ID: 908656 (history)  
Form: Version 2.0  
Age: 26.0  
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 039K202A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Lip swelling, Pruritus, Rash, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Returned to Vaccine Clinic approx. 60 minutes post vaccination with generalized itching, hive-like rash on chest, arms, and legs and "mild" lip swelling. VS normal and stable during clinic observation. O2 Sat at 100%. Evaluated by onsite physician. Received total of 5omg diphenhydramine during observation. D/C''d in 2 hrs with less itching and resolving rash. Accompanied and driven home by friend. Spoke with EH nurse on 12/24/2020 and stated additional 50 mg diphenhydramine at home 12/23/2020. Mild, fading rash today. PLAN: will be evaluated by Allergy Clinic and if cleared, will receive 2nd dose of vaccine in Allergy Clinic.


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