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

This is VAERS ID 903990

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Case Details

VAERS ID: 903990 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Colorado  
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 EJ1685 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Injection site pain, Injection site streaking, Local reaction, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: A cool item was placed on her arm. She was referred to the ER for medical clearance. She was evaluated, determined to have a local reaction and was discharged. Recommended to take benadryl if symptoms persist.
CDC Split Type:

Write-up: The individual developed a quarter size welt immediately after receiving the vaccine. Within the first 5-10 minutes post vaccination, the individual was complaining of pain at the injection site going down her arm, red streaks were visible from the injection site, and she did develop some difficulty breathing, which may have been related to the situation and the mask she was wearing.


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