Background: Immune checkpoint inhibitors (ICIs) have revolutionized treatment for stage IV non-small cell lung cancer (NSCLC) patients. Immune related adverse events (irAEs) are the diverse immunologic side effects of patients receiving ICIs and may result in significant patient morbidity, subsequently impacting quality of life. If severe enough, irAEs may lead to hospitalization and may necessitate administration of immunosuppressants or IL-6 receptor antagonists. Our study sought to characterize irAEs in a patient population receiving ICIs at a rural tertiary care center. Methods: This was an IRB-approved retrospective cohort study using SPSS version 28. Patients with stage IV NSCLC receiving ICIs at ECU Health Medical Center were analyzed and 190 patients met inclusion criteria. Results: Of our cohort, 66.3% (n = 126) experienced at least one irAE of any grade, 46.3% (n = 88) were hospitalized due to grade 3 or 4 irAE, 55.7%(n = 106) were either started on steroids or had a dose increase to treat the irAE, 48.9% (n = 93) received immunosuppression to treat the irAE, and 41.5% (n = 79) had immunotherapy held either temporarily or permanently due to the irAE. 25.7% (n = 49) were rechallenged and 18.9% (n = 36) experienced an irAE after being rechallenged. 34.7% (n = 66) experienced pneumonitis, 22.1%(n = 42) constitutional symptoms, 17.8%(n = 34) gastrointestinal, 10.5%(n = 20) neurological, 10.5%(n = 20) dermatological, 6.8%(n = 13) endocrine, 3.6%(n = 7) hematological, 3.1%(n = 6) musculoskeletal, and 3.1%(n = 6) cardiovascular irAEs. When adjusting for race, sex, line of therapy, and histological type, logistic regression analysis yielded no significant difference in the probability of developing an irAE when comparing patients treated with nivolumab versus atezolizumab and pembrolizumab. Patients treated with atezolizumab (OR:0.17; p = 0.020; 95% CI:0.039-0.757) and pembrolizumab (OR:0.20; p = 0.021; 95% CI:0.055-0.785) were less likely to be hospitalized for an irAE when compared to patients treated with nivolumab. When rechallenged, no difference was noted in recurrent irAE development when comparing pembrolizumab and nivolumab. Cox regression analysis demonstrated that patients treated with atezolizumab (OR:0.36; p = 0.010; 95% CI:0.167-0.781) and pembrolizumab (OR:0.29; p < 0.001; 95% CI:0.291-0.148) had better OS when compared to nivolumab. No difference was evident when comparing White and Black patients experiencing any grade irAE (n = 69, n = 53), grade 3 or 4 irAE (n = 44, n = 40), OS (n = 104, n = 80), and PFS (n = 104, n = 80). Conclusions: Our demonstrated irAE side effect profile is similar to those of published studies. No racial disparities were noted in our cohort when analyzing for any grade irAEs, grade 3 or 4 irAEs, OS, and PFS. Our study yields clinically pragmatic insight into better understanding how various factors, such as ICI selection and race, may impact patient outcomes.