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

This is VAERS ID 913233

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Case Details

VAERS ID: 913233 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Utah  
Vaccinated:2020-12-29
Onset:2020-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic reaction, Oxygen saturation normal, Pruritus, Swollen tongue, Throat tightness, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 10:30 AM After receiving the COVID-19 vaccine, the patient experienced an anaphylaxis reaction that included, throat closing and tongue swelling sensation, itchiness, and hives on her bilateral arms and legs. Patient received 65 mg of Benadryl IV, 125 mg SoluMedrol IV, two doses of 0.3 epinephrine IM, 1 mg of Ativan, and 4 mg of Zofran, then taken to the ED for further monitoring. Patient was on 2L NC for comfort, sats in mid 90s off oxygen, and monitored the patient for a few hours. Patient discharged to home with stable vital signs off oxygen and a steady gait.


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