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

This is VAERS ID 902791

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Case Details

VAERS ID: 902791 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Kansas  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Dysphagia, Hypersensitivity, Hypoaesthesia, Hypoaesthesia oral, Paraesthesia, Paraesthesia oral, Pharyngeal swelling, Sensory disturbance, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (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: Epi-pen as needed, synthroid
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: Amoxicillin, Bactrim, Erythromycin, Augmentin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: :1039: Responded to notification of potential adverse reaction after receiving COVID-19 vaccination. Pt had been escorted from observation area to emergency area with PA with c/o tightness in throat. On my arrival, pt was eupneic, p/w/d, ambulatory, NAD. Vitals @ 1039: P72, 100% pulse ox on RA Vitals @ 1056: P72, 98% pulse ox on RA, 112/78 seated. Administered 25mg diphenhydramine po per PA @ 1050, pt swallowed with water. Called 911 for EMS response @ 1103 per instruction from provider. Vitals @ 1103: 98% pulse ox on RA, P74, denies shortness of breath or pain. Off phone with EMS @ 1108, en route. EMS on site @ 1115, report given to medic. Pt left with EMS en route to ED @ 1116. Report called to ED Charge Nurse @ 1121. Patient presented to vaccination clinic. Patient received her vaccination at approximately 1021. Patient reports symptoms onset at approximately 1038 with tightness of the throat and difficulty swolowing. She described it as a swelling of the throat sensation. She states she had a sensation moving from her head to her toes as in a "wave ". Patient denied shortness of breath, chest pain denies nausea. Patient denies hives or rashes or pruitis. Patient was assessed and moved to the emergency area. Her symptoms continued with some improvement. At this point time 25 mg of Benadryl was administered orally. Approximately 10 to 15 minutes after administration the patient developed numbness tingling around the upper lip, the right upper extremity. She denied shortness of breath or chest pain. She denied increasing severity of the throat sensations. Pertinent past medical history: Reactions bee stings currently carries EpiPen. She is not had any previous reactions to vaccinations. Allergic reaction. The patient symptoms seem to continue with the numbness tingling around the lips after administration of the Benadryl. Hand tingling of the right upper extremity also continued although it was decreasing. Her symptoms of the tightness of the throat remain the same. She did not develop shortness or breath or chest tightness or pain. At this time I feel be prudent to evacuate the patient to higher level care. Patient was evacuated at 11:16 by ambulance service.

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