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From the 7/23/2021 release of VAERS data:

This is VAERS ID 1330993



Case Details

VAERS ID: 1330993 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Erythema, Injection site erythema, Injection site paraesthesia, Rash, Rash macular
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Peanuts, Animal Hair, Grass
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 15-year-old, male. Alert, oriented X4, clear speech, able to answer to questions. No known medical history. History of anaphylaxis twice in past, requiring the use of epinephrine. History of allergies to peanuts, animal hair, and grass. At 11:43 am, the patient received his first dose of Pfizer (lot number EW0185, expires on 08/2021) on left deltoid. Patient walked with a steady, balanced gait to EMT observation area. At 12:00 pm, patient''s mother notified EMT that patient had blotchy redness in left hand. Lead RN responded immediately and assessed the patient. Upon observation, the patient had localized redness at the injection site, with erythema on the entirety of his back and hands. Patient was assisted patient to anti-gravity chair. Patient states he feels "tingling" at injection site. Patient denied SOB, itching, and dizziness. Patient remained A&Ox4 and talking to EMT. RN requested vitals Q5 minutes for 30 minutes while she drew up 1.0 mL of IM Benadryl. At 12:02 pm: BP of 108/70, HR 78, SPO2 98%. At 12:08 pm, the redness and rash on patient''s arm and back had completely subsided. Patient denies feeling tingling sensation at injection site. At 12:10 pm: BP of 110/67, HR 75, SPO2 99%. Patient''s mother declined use of IM Benadryl. Lead RN education patient and mother on signs and symptoms of anaphylaxis, and requested the patient stay for an additional 20 minutes for monitoring. RN disposed of 1.0 mL dose of Benadryl. At 12:18 pm: BP of 110/70, HR 79, SPO2 99%. At 12:26 pm: BP of 108/70, HR 82, SPO2 99%. At 12:37 pm: BP of 106/70, HR 85, SPO2 97%. Lead RN provided patient''s mother with education concerning when to call 9-1-1, including worsening of symptoms and trouble breathing. Patient was instructed to follow up with PCP and allergist. At 12:40 pm, patient stood up from chair, denied lightheadedness and dizziness. Patient walked to car with steady, balanced gait. Patient''s mother drove patient home.


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