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

This is VAERS ID 1416048



Case Details

VAERS ID: 1416048 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW3143 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow), COVID-19 (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: EPIPEN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Peanut allergy
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:No - Negative COVID-19 test
CDC Split Type: GBPFIZER INC2021657235

Write-up: Anaphylaxis; This is a spontaneous report from a contactable healthcare professional received from the Regulatory Agency (RA). The regulatory authority report number is GB-MHRA-WEBCOVID-202106060111378330-9YQCV. Safety Report Unique Identifier is GB-MHRA-ADR 25426658. A 32-year-old male patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 03Jun2021 (lot number: EW3143) as single dose for COVID-19 immunisation. Medical history included peanut allergy. He has not had symptoms associated with COVID-19 and not enrolled in clinical trial. Concomitant medication included epinephrine (EPIPEN). The patient experienced anaphylaxis on 03Jun2021 with outcome of recovered on 03Jun2021. Case narrative: The patient reported feelings of anaphylaxis similar to when he had peanut allergy. Epipen discharged. He was monitored and taken to a hospital. He underwent lab tests and procedures which included COVID-19 virus test: no - negative COVID-19 test on an unknown date. Case was reported as non-serious by health authority. No follow-up attempts are possible. No further information is expected.


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