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

This is VAERS ID 1779216

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Case Details

VAERS ID: 1779216 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-07
Onset:2021-09-11
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NDC:59267-1000- / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pruritus, Rash maculo-papular, 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: Lisinopril 10/12.5 mg daily Atorvastatin 10 mg daily Omega 3 CoEnzyme Q Ca with Vit D3
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: None
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Severe maculo papular rash on the body; itchy; pinkish with wheel formation. Will clear after taking Claritin 10 mg initially but will reappear. Now Taking Allegra 180 mg in am and Claritin 24 Hr. in PM daily for at least one week. Rash disappears only to reappear a few hours later and then goes away again.


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