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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1375954



Case Details

VAERS ID: 1375954 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Sensation of foreign body
SMQs:, Anaphylactic reaction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: LATEX, EGGS REPORTED ON VARS. AT TIME OF VACCINATION SHE REPORTED ALSO PINEAPPLE, SEAFOOD, PEANUTS
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT WAS MONITORED FOR 15 MINUTES BUT STATED SHE FELT LIKE SHE HAD A LUMP IN HER THROAT. SHE HAD NO SHORTNESS OF BREATH OR ANY OTHER REACTIONS. SHE KEPT SAYING HER THROAT WAS BOTHERING HER AND SHE ASKED US TO CALL EMS. THEY ARRIVED AND SHE LEFT WITH THEM.


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