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From the 11/19/2021 release of VAERS data:

This is VAERS ID 912619

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Case Details

VAERS ID: 912619 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Illinois  
Vaccinated:2020-12-16
Onset:2020-12-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER EK5730 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Blood pressure increased, Dyspnoea, Ear swelling, Erythema, Flushing, Heart rate increased, Hypoaesthesia oral, Oral discomfort, Oropharyngeal discomfort, Paraesthesia oral, Rash, Skin burning sensation, Swollen tongue, Tongue erythema
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Jardiance, novolog, novolin n, lisinopril, prevacid, mirena, cetrizine
Current Illness:
Preexisting Conditions: Diabetes mellitus type 2, hypertension, high triglycerides
Allergies: metformin, cephalexin
Diagnostic Lab Data: Any tests done would have been 12/16/2020 none were done to my knowledge
CDC Split Type:

Write-up: Right side tongue numbness, tingling and burning in/around lips, elevated heart rate 136+, Blood pressure spike 165/105. Shortness of breath believed to be r/t elevated heartrate. Within 10 mins of shot. Face flushed, redness worsened with some swelling to ears and tongue skin felt like a sun burn rawness. Throat tugging noted. Dispatched an ambulance, had my husband take me around corner to ER where I was treated for anaphylaxis with 1 dose of Epi IM, IV solumedrol, and two rounds of benadryl IV. I was monitored and sent home on steroids, benadryl, and cimetidine for several days. I was issued an Epi Pen at that time. The rash and redness with feeling of burning has come and gone since as well as the tongue numbness on right side.


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