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

This is VAERS ID 1450153



Case Details

VAERS ID: 1450153 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram normal, Dizziness, Dyspnoea, Electrocardiogram abnormal, Fatigue, Fibrin D dimer, Full blood count, Leukocytosis, Nausea, Pleuritic pain, Pyrexia, Swelling face, Troponin normal, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: eczema
Allergies: None
Diagnostic Lab Data: ED visit on 7/1: D-dimer 603, troponin negative, CBC with leukocytosis, normal lipase, EKG with ST abnormality and inferior lead T wave inversions, normal CTA w/wo contrast. Office visit 7/6: EKG with resolved T wave inversions, repeat d-dimer, BNP and troponin sent (pending)
CDC Split Type:

Write-up: Patient developed fatigue 3 hrs post injection. The following day, developed fever to 103F, nausea and vomiting, dizziness and pleuritic chest pain, difficulty breathing. fever last for 2 days. Went to ED for evaluation on day 3 (7/1). Symptoms ultimately resolved, but then developed facial hives and facial swelling on day 5 post vaccine.


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