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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 903776

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Case Details

VAERS ID: 903776 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Michigan  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Public       Purchased by: ?
Symptoms: Feeling hot, Pruritus, Skin warm, Swelling face, Tachycardia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), 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: Arm swelling and hand swelling after Flu vaccine in 2020. Also numbness and tingling.
Other Medications: Synthroid, multi-vitamin, vitamin D3, elderberry, magnesium, dulera inhaler.
Current Illness: N/A
Preexisting Conditions: Asthma, hypothyroidism.
Allergies: Shellfish, pecans, sensitive to preservatives
Diagnostic Lab Data: Not applicable
CDC Split Type:

Write-up: Hives, itching, warmth on bilateral face and neck and chest. Tachycardia. Facial swelling.

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