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From the 11/26/2021 release of VAERS data:

This is VAERS ID 903973

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Case Details

VAERS ID: 903973 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: California  
Vaccinated:2020-12-18
Onset:2020-12-18
   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 EK5730 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Lip pruritus, Oral pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Bactrim
Diagnostic Lab Data: Took Zytrec and was sent to Urgent Care Clinic
CDC Split Type:

Write-up: Rash on his back with welts, mild itchiness of the lips and mouth and no SOB.


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