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

This is VAERS ID 908003

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Case Details

VAERS ID: 908003 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Michigan  
Vaccinated:2020-12-21
Onset:2020-12-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ELO140 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic reaction, Chest discomfort, Dyspnoea, Electrocardiogram, Tachycardia, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ibuprophen
Current Illness: none
Preexisting Conditions: none
Allergies: Gadolinium MRI dye
Diagnostic Lab Data: EPINEPHRINE, SOLUMEDROL, BENADRYL, PEPCID, EKG (ST). 12/21 3:14PM REPEAT EVENT 12/22 WITH ADMISSION TO OBS UNIT FOR OBSERVATION
CDC Split Type:

Write-up: ANAPHLACTIC REACTION, SOB, CHEST PRESSURE, TIGHTNESS IN THROAT, TACHYCARDIA


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