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

This is VAERS ID 1776880

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Case Details

VAERS ID: 1776880 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-01
Onset:2021-10-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Discomfort, Fatigue, Pain, Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamin D 1000 IU by mouth daily
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: None thus far. Plan is to schedule consult with allergist/immunologist to discuss above and have evaluation of ongoing urticarial rash.
CDC Split Type:

Write-up: Pfizer booster administered on 10/1/21 (9 mos post 2nd Pfizer vaccine) without issue. No adverse side effect from 1st or 2nd doses Pfizer. Felt significant body aches fatigue ~12 hours post booster into following day. Not a big concern though did not have this from either 1st, 2nd dose. 2 days post booster broke out with significant urticarial rash posterior L leg, few hives on R leg and torso. Extreme pruritus area of urticaria. Some extension of rash area over next couple days. Rash has not resolved, but is stable 10 days post booster. Few scattered, isolated hives have appeared on legs over the week since initial rash outbreak. Flare ups typical of histamine response when hot, or any increased blood flow to area. OTC Zyrtec 10 mg PO taken most days since outbreak helpful for itching, discomfort. Triamcinolone cream applied topically to rash somewhat helpful too.


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