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From the 4/30/2021 release of VAERS data:

This is VAERS ID 903514



Case Details

VAERS ID: 903514 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2020-12-17
Onset:2020-12-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Pruritus, Rash, Rash erythematous, Rash maculo-papular, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine recipient was administered the vaccine at 11:30 am and then around 1:30 pm started to feel dizzy with hives and itching to his arms. The vaccine recipient was sent to the emergency department for further evaluation. There was an erythematous macular/papular rash on bilateral arms. He was administered diphenhydramine 12.5 mg IV, famotidine 20 mg IV, and methylprednisolone 125 mg IV. After reexamining, the patient felt much better, no dizziness, no itching, and no rash. He was discharge to home at 4:57 pm same day.


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