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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 909784



Case Details

VAERS ID: 909784 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Arizona  
Vaccinated:2020-12-24
Onset:2020-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Facial discomfort, Pain in extremity, Pruritus
SMQs:, Anaphylactic reaction (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), 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? No
Hospitalized? No
Previous Vaccinations: influenza H1N1 2009
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: FLU vaccine H1N1 2009 with near anaphylaxis
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 10 minutes following vaccination, itchiness, "fullness in face and chest" She took benadryl and cetirizine due to known adverse reaction to H1N1 vaccine Overall resolved in 30 min no worsening Arm achiness x2 days


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210507&IDNUMBER=909784

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