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From the 5/7/2021 release of VAERS data (an older release, current is 1/7/2022):

This is VAERS ID 903197

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Case Details

VAERS ID: 903197 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Alaska  
Vaccinated:2020-12-17
Onset:2020-12-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dysphonia, Rash, Swollen tongue, Tachycardia, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl 25mg 1hr before vaccine
Current Illness: no
Preexisting Conditions: no
Allergies: no known
Diagnostic Lab Data: none at this time
CDC Split Type:

Write-up: Swollen tongue, scratchy throat, rash, tachycardia, and raspy voice


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