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

This is VAERS ID 909209

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Case Details

VAERS ID: 909209 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2020-12-24
Onset:2020-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Anaphylactic reaction, Angioedema, Condition aggravated
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Mild allergic reactions to flu vaccines, but due to history of septic pneumonia history x 2 as a result of influenza A, I take t
Other Medications: Lisinopril, Prilosec
Current Illness: none
Preexisting Conditions: History of anaphylaxis.
Allergies: Additives, steroids, fragrances, color dyes, bactrim
Diagnostic Lab Data: n/a.
CDC Split Type:

Write-up: Mild anaphylaxis with angioedema of the tongue within minutes of injection.


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