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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1758793

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Case Details

VAERS ID: 1758793 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphagia, Eructation, Rash, Rash erythematous, Rash pruritic, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: pneumovax, thimerosol, sucralfate
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5 minutes after vaccination the patient started to get a red itchy rash on forearm of the arm that it was administered. She Took 50mg of benadryl to treat the symptoms. Symptoms progressed into difficulty swallowing, belching, and vomitting. An ambulance was called for the patient''s further care.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1758793


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