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

This is VAERS ID 1376384



Case Details

VAERS ID: 1376384 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Nausea, Nervousness, Throat tightness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Hypoglycaemia (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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient DOB: 11/09/1967. Received her first dose Pfizer vaccine (LOT#: EW0187 EXP: 8/2021) at 15:26 on 6/01/21. Patient alerted EMT at 16:05. Patient stated that she felt a closing sensation in her throat. Patient was able to talk and did not have SOB. Patient stated she also felt nauseous and shaky. Patient stated that she felt very nervous before receiving the vaccine. PHN asked patient to stay an extra 30 minutes for further observation. Patient agreed to stay. EMT took patient vital signs. BP: 120/65, pulse: 76, O2: 96%. PHN assessed patient. PHN offered patient Diphenhydramine. Patient stated she was allergic to Diphenhydramine. Patient could not recall signs and symptoms that occurred with Diphenhydramine intake. Patient refused Diphenhydramine at 14:12. PHN offered patient EpiPen. Patient denied EpiPen at 16:13. Patient stated she was feeling better. PHN gave patient water. Patient was able to swallow water without any trouble. Patient stated her throat no longer felt like it was closing. Patient was talking the entire time with PHN and EMT. Patient denied any SOB or difficulty swallowing. EMT reassessed patient and retook vital signs at 16:25. BP: 120/68, pulse: 79, O2: 97%. Patient stated that she no longer felt any of her initial symptoms. EMT reassessed and retook patients vital signs at 16:36. Patient stated that she no longer had any symptoms. Patient completed her 30 minutes of observation. Patient was educated on worsening signs and symptoms of the vaccine side effects and when to call EMS or go to the ED/urgent care. Patient verbalized understanding of education. Patient left vaccination site at 16:40 unassisted and with a steady gait.


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