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

This is VAERS ID 910020

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Case Details

VAERS ID: 910020 (history)  
Form: Version 1.0  
Age: 53.0  
Sex: Female  
Location: Unknown  
Vaccinated:2020-12-23
Onset:2020-12-23
   Days after vaccination:0
Submitted: 2020-12-23
   Days after onset:0
Entered: 2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 2 LA / -

Administered by: Other       Purchased by: Other
Symptoms: Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: had hives on back and L arm 1 inch medial to vaccine injection site; no lip or tongue edema, no wheezing or stridor Treatment dugs:


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