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

This is VAERS ID 910907

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Case Details

VAERS ID: 910907 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2020-12-22
Onset:2020-12-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactoid reaction, Dizziness, Tachycardia
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Mild intermittent asthma
Allergies: Shrimp - Anaphylaxis
Diagnostic Lab Data:
CDC Split Type:

Write-up: Anaphylaxis symptoms starting about 45 minutes after injection. Initial symptoms were severe light headedness and tachycardia. Epi-pen self administered 5 minutes after onset of symptoms. Symptoms resolved within 30 minutes of Epi-pen administration.


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