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

This is VAERS ID 910723

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Case Details

VAERS ID: 910723 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2020-12-26
Onset:2020-12-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Chest discomfort, Cough, Neutrophil percentage increased, Throat clearing
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol 90 mcg/ Aerosol 2 puffs 4 times day Famotidine 20mg po daily Prednisone 20mg po 2 times day Diphenhydramine 25 mg po Q 6 hrs prn
Current Illness: UTI 11/28/2020
Preexisting Conditions: Hx Asthma Hx Uterine Sarcoma
Allergies: MRI Dye, NSAIDs
Diagnostic Lab Data: 12/26 CXR: Negative, no pneumonia, edema or pneumothorax Lab work: Neutrophils 83.6
CDC Split Type:

Write-up: 10 minutes after the vaccination, she began clearing her throat, within 30 minutes began coughing, which led to chest tightness. Was evaluated in the ER and admitted for observation. Given: Prednisone 40mg po, Benadryl 25mg po Duoneb x 3 and Pepcid 20mg


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