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

This is VAERS ID 1454403



Case Details

VAERS ID: 1454403 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Pruritus, Rash papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received his second dose of the Pfizer vaccine today. He is accompanied with his mother. He had no issues with his first dose. Approximately 15 minutes after administration, patient developed mild itching to his bilateral forearms and on examination, he had a few scattered erythematous papules to his bilateral forearms. He had no other rash. No swelling. He had no other symptoms. No shortness of breath, wheezing, cough or chest pain. No angioedema or throat/tongue swelling. He was talking in complete sentences and eating/drinking without any issues. Lungs were clear. See vitals below. Patient took Claritin last night and Allegra this morning for a history of seasonal allergies. He was monitored for greater then 30 minutes. The pruritus had improved, the rash did not get any worse. Patient and mother felt comfortable going home and had no further questions or concerns. Patient will go to the ED with any severe/acute symptoms. Vitals 07/07/21 1147 07/07/21 1148 BP: 110/80 108/80 Pulse: 80 79 Resp: 16 SpO2: 98% 98%


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