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From the 12/30/2020 release of VAERS data (an older release, current is 1/14/2022):

This is VAERS ID 907485

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Case Details

VAERS ID: 907485 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic reaction, Electrocardiogram, Full blood count, Hypertension, Intensive care, Pharyngeal swelling, Tachycardia
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypertension (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: azelastine 137 mcg (0.1 %) nasal spray Commonly known as: ASTELIN buPROPion XL 150 mg 24 hr tablet Commonly known as: WELLBUTRIN XL cholecalciferol 50 mcg (2,000 unit) tablet Commonly known as: VITAMIN D3 doxycycline hyclate 100 mg capsule
Current Illness: Obstructive sleep apnea hypopnea, mild Pre-diabetes Other migraine without status migrainosus, not intractable Dyslipidemia PMDD Obesity Kidney stones
Preexisting Conditions: Obesity Migraine PMDD
Allergies: Allergies Hydrocodone-acetaminophen Oxycodone-acetaminophen Sulfa (sulfonamide Antibiotics) Tramadol
Diagnostic Lab Data: CBC EKG
CDC Split Type:

Write-up: Anaphylactic with throat swelling , tachycardia and high BP. Pt was given steroids, epi pen, Benadryl and observed in ICU overnight.

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