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From the 1/14/2022 release of VAERS data:

This is VAERS ID 909510

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Case Details

VAERS ID: 909510 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2020-12-26
Onset:2020-12-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Feeling hot, Flushing, Hyperhidrosis, Paraesthesia oral
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: Latex Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received Moderna COVID-19 vaccine IM in the Administration clinic. During the observation period, patient reported feeling flushed, warm, sweaty, with lip tingling. Vital signs 138/95, HR98, 02 Sat 98%. Proceed out call. Patient transported via wheelchair to ED for further monitoring. In ED, monitored with resolution of tingling of the lips, cheeks still with slight flushing to them. No sob or abd pain or tongue/lip swelling, no worsening rash. Encouraged followup with working well clinic. Patient was discharged home 4 hours later.


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