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

This is VAERS ID 1378245



Case Details

VAERS ID: 1378245 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Flushing, Paraesthesia oral, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (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: Clonidine and duloxetine per patient profile.
Current Illness: None reported.
Preexisting Conditions: Depression.
Allergies: NKA.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient complained of facial flushing, tingling lips, and his throat feeling like it was tightening. Nurse administered 25mg IM Benadryl per clinic protocol. The reaction resolved after administration of IM Benadryl.


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