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From the 9/17/2021 release of VAERS data:

This is VAERS ID 611803

Case Details

VAERS ID: 611803 (history)  
Form: Version 1.0  
Age: 17.0  
Sex: Female  
Location: Connecticut  
Submitted: 2015-11-11
Entered: 2015-11-25
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Injection site pruritus, Pain, Pruritus, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 2015270148

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative and from a contactable nurse. A 17-year-old female patient of an unspecified ethnicity received, on 06Aug2015 11:30, TRUMENBA (Lot# J29203, expiration date Jun2016), intramuscular at 0.5 ml single dose in the left deltoid. Relevant medical history and concomitant medications were unknown. On an unspecified date, in Aug2015, the patient experienced itchy at the site of injection, big rash red, sore and itchy. Treatment received included BENADRYL, ALLEGRA and ZYRTEC. The patient did not recover from the event, rash erythematous; while clinical outcome of the other events was unknown. There was a reasonable possibility that the events was related to TRUMENBA. Follow up (01Sep2015): 06 Aug 2015 New information obtained from a contactable nurse includes: lot# and expiration date, route of administration, dose, anatomical location and start date (updated) for TRUMENBA; patient''s date of birth. Follow-up attempts completed. No further information expected.

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