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

This is VAERS ID 1411902



Case Details

VAERS ID: 1411902 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0779 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Body temperature, Cold sweat, Erythema, Nausea, Pallor, Pruritus, Pulse abnormal, Throat tightness, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ALLEGRA
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Dyspnoea; Food allergy (dyspnoea with peanut, almond and lotus root urticaria with beef and mackerel); Urticaria
Allergies:
Diagnostic Lab Data: Test Date: 20210604; Test Name: body temperature; Result Unstructured Data: Test Result:36.6 Centigrade; Comments: before vaccination
CDC Split Type: JPPFIZER INC2021654100

Write-up: vomiting; cold sweat; pallor facial; Anaphylaxis; Systemic pruritus without rash; redness; Central pulse weakness; Pharynx closed sensation of; nausea; This is a spontaneous report from a contactable physician received from the regulatory authority. Regulatory authority report number is v21111754. A 35-year-old female patient received first dose of BNT162B2 (COMIRNATY, lot number: EY0779, expiration date: 31Aug2021) at the age of 35-years, via an unspecified route of administration on 04Jun2021 at 11:35 at single dose for COVID-19 immunization. Body temperature before vaccination was 36.6 degrees Centigrade. Through the vaccine screening questionnaire, the patient had food allergy: experienced dyspnoea with peanut, almond and lotus root; experienced urticaria with beef and mackerel. The patient was taking fexofenadine hydrochloride (ALLEGRA) orally. The patient had no allergy to the vaccine. The onset of events was on 04Jun2021 at 11:50 (15 minutes after the vaccination), the patient experienced anaphylaxis, systemic pruritus without rash, redness, vomiting, cold sweat, pallor facial, central pulse weakness, pharynx closed sensation of and nausea. The course of the event was as follows: 11:35 vaccination; 11:50 itching, redness; 11:56 vomiting, cold sweat, pallor facial. No respiratory symptoms, no symptoms of blood pressure decreasing, no symptom of palpitation. The patient was diagnosed as anaphylaxis. In that, at 12:06, epinephrine (ADRENALINE) 0.3 ml was administrated through intramuscular injection. An intravenous line was secured, large amount of metoclopramide hydrochloride (PRIMPERAN) was administrated intravenously. Methylprednisolone sodium succinate (SOLU-MEDROL) was administrated through injection via iv drip. The symptoms were relieved (whole process within 1 hour). The ticked symptoms in classification were provided as attachment: Major symptoms: Central pulse weakness. Minor symptoms: systemic pruritus without rash, pharynx closed sensation of, nausea and vomiting. The reporting physician classified the event as non-serious and assessed that the event was related to BNT162B2. There was no other possible cause of the event such as any other diseases. The reporter commented as follows: classification Level 3. Outcome of the events was recovering/resolving.


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