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From the 6/11/2021 release of VAERS data:

This is VAERS ID 902836



Case Details

VAERS ID: 902836 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2020-12-16
Onset:2020-12-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Feeling hot, Flushing, Headache, Injection site erythema, Injection site warmth, Local reaction, Malaise, Nausea, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: Morphine, anaphylaxis
Diagnostic Lab Data: blood glucose 80 No additional tests
CDC Split Type:

Write-up: Patient received covid-19 vaccine. 20+ minutes later patient states she began feeling flushed and nauseous. Patient states she look at her injection site, and it was hot and red. Local reaction approx. 2 inches x 2 inches. Dr. ordered 25 mg oral Benadryl. Vitals stable at 1840 133/88, 66 for pulse and regular, SPO2 99% on room air, respirations 20. Patient continued having complaints of light headedness and nausea. 1850 119/79, 74, 99% RA. Dr. states patient may depart from clinic if able to sit up and walk out, patient given instructions go to ED in symptoms progress. 1857 120/82, 70, 99.4. Patient''s face becomes flushed and hot on left side, patient states she is shaky, and does not feel well at all. 1905 patient transferred to ED on 2L O2 for further evaluation and workup. Narrative ER Medical decision making narrative: Accu-Chek was obtained noting a glucose to be at 80. She received IV fluids as well as Solu-Medrol Benadryl and IV Pepcid. She also received IV Tylenol as she developed a headache while in the emergency department. Headache resolved and she was able to ambulate without assistance. Requested to go home states she felt much improved near normal. Clinical Impression: Adverse reaction to drug Patient Education: Anaphylaxis (ED)


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