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From the 11/19/2021 release of VAERS data:

This is VAERS ID 912946

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Case Details

VAERS ID: 912946 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Virginia  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Senior Living       Purchased by: ?
Symptoms: Anaphylactic reaction, Blood glucose, Hypertension, Lip swelling, Loss of consciousness, Speech disorder, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Lightheadedness but no fainting
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes
Allergies: No allergies
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: After administration of vaccine at 1:00 pm, I looked up and saw patient had fainted in chair, that time was maybe around 1:01 pm. When I rushed over to her, she regained consciousness, noticed she was not able to speak well, nurses removed her mask and we noticed her lips were swollen and was having an anaphylactic reaction, I then administered one dose of Epi-pen at 1:04 pm and called 911. We took her BP but it was high due to the Epipen injection, we tested her blood sugar. When the EMT arrived, they took over and took her to the ER.

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