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From the 1/14/2022 release of VAERS data:

This is VAERS ID 903540

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Case Details

VAERS ID: 903540 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Alabama  
Vaccinated:2020-12-16
Onset:2020-12-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pallor, Pruritus, Tremor, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: None noted
Preexisting Conditions: Unknown
Allergies: unknown to food, allergy to metoclopramide
Diagnostic Lab Data: None
CDC Split Type:

Write-up: After the patient received Covid vaccine, she started experiencing itching. The nurse monitoring the patient noticed she was scratching. The patient continued to itch during the 15 minute observations period but no other adverse effects were noticed. The observation period was extended to 30 minutes and then the patient was released. An hour after she left the vaccination site she experienced an episode of vomiting which resolved. Her husband noticed her to be pale upon returning home. Later that night the patient was visibly shaking and had another episode of vomiting. All symptoms have since resolved.


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