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From the 1/14/2022 release of VAERS data:

This is VAERS ID 903123

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Case Details

VAERS ID: 903123 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Alaska  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time shortened, Alanine aminotransferase normal, Anion gap, Aspartate aminotransferase normal, Basophil count normal, Basophil percentage decreased, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium normal, Blood chloride normal, Blood glucose normal, Blood magnesium normal, Blood osmolarity decreased, Blood potassium decreased, Blood sodium normal, Blood urea nitrogen/creatinine ratio, Blood urea normal, C-reactive protein increased, Chest discomfort, Dizziness, Dyspnoea, Eosinophil count normal, Eosinophil percentage decreased, Fibrin D dimer, Glomerular filtration rate decreased, Haematocrit normal, Haemoglobin normal, Immature granulocyte count increased, Injection site pain, International normalised ratio normal, Lymphocyte count normal, Lymphocyte percentage, Mean cell haemoglobin concentration decreased, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume increased, Monocyte count normal, Monocyte percentage, N-terminal prohormone brain natriuretic peptide normal, Neutrophil count normal, Neutrophil percentage, Palpitations, Platelet count normal, Protein total normal, Rash, Rash erythematous, Red blood cell count normal, Red blood cell sedimentation rate increased, Red cell distribution width normal, SARS-CoV-2 test negative, Troponin T normal, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (narrow), Haematopoietic leukopenia (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Hyponatraemia/SIADH (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (narrow), COVID-19 (broad)

Life Threatening? Yes
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:
Other Medications: Eliquis, Bumetanide
Current Illness: none
Preexisting Conditions: Pulmonary Hypertension Obesity Li-Fraumeni Syndrome H/o Breast Cancer
Allergies: Latex, Propofol, Nickel, Almonds
Diagnostic Lab Data: WBC 9.88 HGB 14.4 HCT 40.8 Platelet Count 292 RBC 4.81 MCV 84.8 MCH 29.9 MCHC 29.9 RDW 12.5 MPV 10.8 Sedimentation Rate 37 Diff Absolute Neutrophils 6.44 Absolute Imm. Granulocyte 0.01 Absolute Lymphocytes - CBC 2.94 Absolute Monocytes - 0.38 Absolute Eosinophils - 0.08 Absolute Basophils - 0.03 Neutrophils 65.2 % Immature Granulocyte 0.1% Lymphocytes 29.8% Monocytes 3.8% Eosinophils 0.8% Basophils 0.3% Coagulation Prothrombin Time 9.8 sec INR 1.0 Partial Thromboplastin Time 26.4 sec D-DIMER,QUANT 0.67mg/L ROUTINE CHEMISTRY NT-proBNP 29 BUN/Creatinine Ratio 11.4 Osmolality Calculated 277 GFR (estimated) 67 Sodium 139 Potassium 3.0 Chloride 98 CO2 30 BUN 10.7 Creatinine 0.94 Glucose Level 100 Calcium 9.5 Magnesium 1.9 Protein,Total 7.4 Albumin 4.5 AST (SGOT) 18 ALT (SGPT) 24 Alkaline Phosphatase 94 Bilirubin, Total 0.8 CRP, High-Sensitivity 1.72 Anion Gap 14 CARDIAC ISOENZYMES Troponin T <0.01 Molecular Diagnostics SARS-CoV-2 - negatieve
CDC Split Type:

Write-up: About 5 minutes after the vaccine developed chest tightness, increased work of breathing, palpitations and severe dizzyness. Transferred to the ED where i received oxygen, IV benadryl, IV fluids and monitoring. Released after about 4 hours and continue to take benadryl 50 mg PO q 4 hours. Also developed red facial rash (unknown time) Pain at injection site began the morning after the injection.

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