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From the 11/12/2021 release of VAERS data:

This is VAERS ID 902758

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Case Details

VAERS ID: 902758 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Alaska  
Vaccinated:2020-12-16
Onset:2020-12-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abnormal sensation in eye, Blood test, Dizziness, Dry mouth, Euphoric mood, Periorbital swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Corneal disorders (broad), Vestibular disorders (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: MVI- generic brand
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: blood drawn. un sure of test ordered.
CDC Split Type:

Write-up: @ ~5 min felt cotton mouth. Got up to ask if he could go early. Then at 10 min post injection, felt eyes feeling weird and he felt "high". As in lightheaded. @ 10 min, skin surrounding the eyes are puffy. Given 25 mf benedryl. No immediate SOB or wheeze. No lip or mouth or throat swelling. Taken to ED. Given IM epi 1:1000 0.3ml. Pepcid and more benedryll PO.


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