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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1208527



Case Details

VAERS ID: 1208527 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-13
Onset:2021-04-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 4 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Alcohol test negative, Back pain, Blood electrolytes normal, Chills, Computerised tomogram head, Computerised tomogram normal, Condition aggravated, Full blood count normal, Hallucination, auditory, Hallucination, visual, Insomnia, Lymphocyte count decreased, Mental impairment, Neutrophil count increased, Pain, Procalcitonin, Urine analysis
SMQs:, Haematopoietic leukopenia (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: TYLENOL
Current Illness: BACK PAIN- ONGOING FOR SEVERAL MONTHS
Preexisting Conditions:
Allergies: NONE
Diagnostic Lab Data: Work up in the Emergency Department included CBC, electrolytes, Urine drug screen, ETOH, procalcitonin and urinalysis. All were normal, with the exception of an elevated neutrophil count and low lymphocyte count. Head CT was normal as well. All were 14 Apr 2021.
CDC Split Type:

Write-up: Patient received his second dose of Pfizer COVID Vaccine on 13 Apr 2021 at about 9:30 AM. That afternoon, he began to experience chills, body aches and back pain. Later that night, unable to sleep, he began to experience visual hallucinations, to include a demon to his immediate left, a candle in his far left periphery, shackles, the room going dark and feeling like he was stuck in a time loop. In addition he experienced auditory hallucinations, to include a demon yelling and people whispering. He took ibuprofen that afternoon for his chills. No known psychiatric history or drug use. He denied suicidal ideation. Has a history of back pain for which he has been seeing physical therapy for several months. Enjoys his job with no identifiable unique stressors. Work up in the Emergency Department included CBC, electrolytes, Urine drug screen, ETOH, procalcitonin and urinalysis. All were normal, with the exception of an elevated neutrophil count and low lymphocyte count. Head CT was normal as well.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1208527

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