Background Epinephrine is widely used for its life-saving properties in acute medical conditions. However, epinephrine is associated with a range of adverse effects due to its broad receptor activation. This study aims to further explore the adverse event profile of epinephrine, providing insights into its safety and optimizing its therapeutic application. Method In this study, we extract all data from the 2004 to 2024 using the FAERS database. We adopted report odds ratio, proportion report ratio, bayesian confidence propagation neural network, and multi-item gamma-poisson shrinkage to analyze the data mining significant AE signals. Besides, we collect the onset times of epinephrine associated with AEs. Result Our study identified a total of 15,865 case reports of epinephrine as the primary suspect drug (PS) from FAERS. After data cleaning and analysis, a total of 2,338 AE signals were identified across 27 SOCs. The top three PTs are: drug hypersensitivity, hypotension, and stress cardiomyopathy. Notably, several undocumented adverse events not mentioned in the instructions including stress cardiomyopathy, systolic anterior motion of mitral valve, left ventricle outflow tract obstruction, kounis syndrome, chondrolysis, horner’s syndrome, compartment syndrome, oral hypoesthesia, and paresthesia. Conclusion When using epinephrine in clinical practice, it is essential to closely monitor the allergic reactions, malignant arrhythmias, and adverse effects on the circulatory system mentioned in the drug labeling. Additionally, vigilance is required for adverse reactions not listed in the labeling, and careful consideration should be given to the selection of epinephrine auto-injectors.