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From the 12/18/2020 release of VAERS data (an older release, current is 11/19/2021):

This is VAERS ID 903175

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Case Details

VAERS ID: 903175 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Maine  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Pruritus, Rash pruritic, Rhinorrhoea, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), 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: ADHD meds
Current Illness: None known
Preexisting Conditions: None
Allergies: environmental
Diagnostic Lab Data: None
CDC Split Type:

Write-up: sudden onset of rinorrhea 5 minutes after receiving vaccine. then itching near ears, 5 minutes later had diffuse itching a rash, was sent to ED. There was evaluated for mild shortness of breath and hives on wrists. Did NOT et epi but did get benedryl and steroids, discharge home

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