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From the 5/7/2021 release of VAERS data (an older release, current is 10/15/2021):

This is VAERS ID 906818



Case Details

VAERS ID: 906818 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Missouri  
Vaccinated:2020-12-21
Onset:2020-12-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Paraesthesia oral, Somnolence, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: During 15 min observation, employee reported tingling in her lips. She is allergic to grass and has experienced this feeling when she is having an allergic reaction. Employee taken to gurny, VS taken. No hives noted. Reported her throat feels a little tight. 50 mg of Benadryl given. See attachment for VS record. 1:1 observation by RN. No further s/s. Employee states points to her flowers and says it could be the flowers my mom sent me for vaccination day. Monitored employee until 1950 when she was taken home by a co-worker. Employee states she has improved s/s and is now just drowsy. Informed to discuss reaction with PCP and/or EH. Instructed to call EMS or go to ED if symptoms come back.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210507&IDNUMBER=906818

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