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From the 6/4/2021 release of VAERS data:

This is VAERS ID 904115



Case Details

VAERS ID: 904115 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2020-12-15
Onset:2020-12-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2020-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Petechiae, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (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: acyclovir 400mg tid, albuterol hfa 180mcg q4h prn, buproprion SR 100mg bid, diclofenac 1% gel 4g qid prn, gabapentin 100mg tid, hydroxychloroquine 200mg bid, ibuprofen 800mg q8h prn, loratadine 10mg qday prn, montelukast 10mg qhs, omeprazol
Current Illness:
Preexisting Conditions: left sided heart failure, raynaud''s syndrome, sick sinus syndrome, GERD, systemic lupus erythematosus
Allergies: codeine, latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA PATIENT DEVELOPED HIVES ON INCISION SCARS ON HER RIGHT FOREARM AND CHEST AT 15 MINUTES POST VACCINATION. AT 24 HOURS POST VACCINATION, PATIENT DEVELOPED PETECHIAE ON INCISION SCAR ON CHEST AND LEFT COLLAR BONE.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=904115


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