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From the 12/30/2020 release of VAERS data (an older release, current is 11/26/2021):

This is VAERS ID 903415

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Case Details

VAERS ID: 903415 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Arizona  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dizziness, Hypersensitivity
SMQs:, Angioedema (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (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: Proair HFA inhaler, Benzoyl Peroxide 10% Gel, Clindamycin 1% Gel, Tretinoin 0.05% Cream
Current Illness: Acne
Preexisting Conditions: Asthma, Allergic Rhinitis
Allergies: NKDA
Diagnostic Lab Data: No labs ordered. Only vitals taken as reported above in Item 18.
CDC Split Type:

Write-up: Patient experienced mild alllergic reaction starting at 4:19pm. The ER staff came to tend to the patient. The patient reported dizziness and weakness. Her vitals are as follows: BP 142/80, O2-99% on room air, Pulse-98, Resp Rate-18, Temp-97.3F. The patient was taken to the ER and received Benadryl 50mg IV and an Epipen. The patient''s pain was 0/10. The patient was reported stable at 4:27pm.

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