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

This is VAERS ID 921553

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Case Details

VAERS ID: 921553 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-01-05
Onset:2021-01-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Erythema, Hypersensitivity, Pruritus, Skin warm
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hypersensitivity (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 19 yo female received COVID Vaccines at 0930, reported to Primary care around 1200 pm with pruritus, erythema and warmth on upper extremities, chest and back. Airway intact, Lungs CTA bilar, NEURO WNL, VS wnl. Will tx for mild allergic reaction, Educated on Anaphylaxis protocol. SM v/u


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