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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1679040

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Case Details

VAERS ID: 1679040 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Pruritus, Rash macular, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Penicillin, Cephalosporin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: About 10 minutes in splotchy skin and all over itching with a tight throat. Urgent care doctor assessed her and treated with Benadryl. Assessed again approximately 10 minutes later then had her transferred over to urgent care for epinephrine shot and prednisone . She started having relief about 15 minutes after.


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