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

This is VAERS ID 910133

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Case Details

VAERS ID: 910133 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2020-12-23
Onset:2020-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2020-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Full blood count normal, Speech disorder, Swollen tongue, X-ray normal
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dementia (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), 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? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Guaifenesin, Albuterol Inh, levothyroxine, amlodipine, coreg, Claritin.
Current Illness: none
Preexisting Conditions: Hypothyroidism, Hypertension, menopause
Allergies: environmental (sneezy/watery eyes), ibuprofen,
Diagnostic Lab Data: Labs completed at 1352. CBC WNL. CRP 7.4. Soft tissue neck xray at 1527 with no acute findings.
CDC Split Type:

Write-up: Noted tongue starting to swell on 12/24 at 1030. Started on left side, then progressed to right side. No SOB, difficulty swallowing or breathing, but staff noted difficulty understanding her speech. Presented to ED at 1300. 50mg Benadryl given IV on 12/24 at 1328 and 125mg solumedrol given IV at 1327. Pt reported improvement in tongue swelling at 1630.


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