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From the 9/17/2021 release of VAERS data:

This is VAERS ID 917722



Case Details

VAERS ID: 917722 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Florida  
Vaccinated:2020-12-28
Onset:2020-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Enlarged uvula, Heart rate increased, Mouth haemorrhage, Oropharyngeal pain, Palpitations, Petechiae, Rash, Rash erythematous, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nexium, Pepcid, Tumeric/ginger tea, Tylenol, ibuprofen
Current Illness: None
Preexisting Conditions: GERD
Allergies: Bactrim
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Received shot at 11:45 am. At 1700 that day developed sensation of racing heart and resting heart rate was 120. Baseline heart rate 80 at rest. This resolved overnight and returned to normal the next day. On 12/31/2020 develop sore throat and noted red vesicle like rash on my throat with petechia on my cheeks (buccal mucosa) and tongue. Swollen uvula. I had a medrol dose pack and Benadryl which I started immediately and rash/sore throat petechia resovlved 36 hours after starting the Medro dose pack. Unsure if this was related the vaccine but wanted to report just in case.


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